Provider Demographics
NPI:1457896946
Name:WESLEY, MARY (CNA, LISW-S, LMSW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:WESLEY
Suffix:
Gender:F
Credentials:CNA, LISW-S, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2416 ROBINWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43620-1025
Mailing Address - Country:US
Mailing Address - Phone:419-318-7272
Mailing Address - Fax:419-386-0984
Practice Address - Street 1:2416 ROBINWOOD AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43620-1025
Practice Address - Country:US
Practice Address - Phone:419-318-7272
Practice Address - Fax:419-386-0984
Is Sole Proprietor?:No
Enumeration Date:2016-12-20
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011069131041C0700X
OHI20020561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1790540946OtherGROUP NPI
OH0324862Medicaid
OH0328261Medicaid