Provider Demographics
NPI:1871273276
Name:POLAKOWSKI, TIMOTHY (MSW, LISW-S, LMSW)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:POLAKOWSKI
Suffix:
Gender:M
Credentials:MSW, 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 1:314 LOUISIANA AVE
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-1461
Mailing Address - Country:US
Mailing Address - Phone:567-331-8601
Mailing Address - Fax:
Practice Address - Street 1:314 LOUISIANA AVE
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-1461
Practice Address - Country:US
Practice Address - Phone:567-331-8601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.15023381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical