Provider Demographics
NPI:1265938401
Name:BENTLEY, EMILY MICHELLE (LSW)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:MICHELLE
Last Name:BENTLEY
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:ANDREGG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:316 N MICHIGAN ST STE 914
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-5665
Mailing Address - Country:US
Mailing Address - Phone:419-246-9405
Mailing Address - Fax:
Practice Address - Street 1:316 N MICHIGAN ST STE 914
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43604-5665
Practice Address - Country:US
Practice Address - Phone:419-246-9405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-05
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.165339101YA0400X
OHS.1903509104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0273990Medicaid