Provider Demographics
NPI:1376049106
Name:MEYERS, LORA KAY (LISW-S)
Entity Type:Individual
Prefix:
First Name:LORA
Middle Name:KAY
Last Name:MEYERS
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:LORA
Other - Middle Name:KAY
Other - Last Name:GOSSETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:104 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:SWANTON
Mailing Address - State:OH
Mailing Address - Zip Code:43558-1336
Mailing Address - Country:US
Mailing Address - Phone:419-852-5667
Mailing Address - Fax:
Practice Address - Street 1:412 MAIN ST
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:OH
Practice Address - Zip Code:43515-1315
Practice Address - Country:US
Practice Address - Phone:419-779-3885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-02
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1302534104100000X
OHI.21029621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0277120Medicaid
OH1437626587OtherGROUP NPI