Patrick R Fullenkamp, LSW, LICDC

NPI #1740436138 in Defiance, Ohio

Provider Information

NPI Number: 1740436138
Entity Type: Individual
Name: Patrick R Fullenkamp, LSW, LICDC
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Social Worker
Credential: LSW, LICDC
Enumeration Date: Aug 18, 2008
Last Updated: Aug 18, 2008

Practice Location

Address: 511 PERRY ST
City: Defiance
State: Ohio
ZIP Code: 43512-2123
Phone: (419) 782-9920

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Social Worker	104100000X	Primary

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