Provider Demographics
NPI:1649758418
Name:VONWALLMENICH, LISA L (QMHS)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:L
Last Name:VONWALLMENICH
Suffix:
Gender:F
Credentials:QMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1624 TIFFIN AVE
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-6852
Mailing Address - Country:US
Mailing Address - Phone:419-422-7800
Mailing Address - Fax:
Practice Address - Street 1:1624 TIFFIN AVE
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-6852
Practice Address - Country:US
Practice Address - Phone:419-422-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-02
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X
OHC.2304659-TRNE101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No172V00000XOther Service ProvidersCommunity Health Worker