Provider Demographics
NPI:1376615211
Name:NOFZIGER, LOWELL M (MSW)
Entity Type:Individual
Prefix:MR
First Name:LOWELL
Middle Name:M
Last Name:NOFZIGER
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 WEST ST
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-1554
Mailing Address - Country:US
Mailing Address - Phone:330-805-6072
Mailing Address - Fax:
Practice Address - Street 1:102 MAIN ST STE 302
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-1434
Practice Address - Country:US
Practice Address - Phone:330-805-6072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-0018161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHNOSW00071Medicare ID - Type Unspecified