Provider Demographics
NPI:1871283275
Name:BIRT, WINDA (MA)
Entity type:Individual
Prefix:
First Name:WINDA
Middle Name:
Last Name:BIRT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5726 SOUTHWYCK BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-1510
Mailing Address - Country:US
Mailing Address - Phone:419-214-1766
Mailing Address - Fax:419-214-1792
Practice Address - Street 1:5726 SOUTHWYCK BLVD STE 200
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-1510
Practice Address - Country:US
Practice Address - Phone:419-214-1766
Practice Address - Fax:419-214-1792
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-09
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251B00000X
OHS.2403484-TRNE390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0016285Medicaid