Provider Demographics
NPI:1104137975
Name:GOTWALS, MICHEL JANE (LISW)
Entity type:Individual
Prefix:MRS
First Name:MICHEL
Middle Name:JANE
Last Name:GOTWALS
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1971 W 5TH AVE
Mailing Address - Street 2:STE 2
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43212-1905
Mailing Address - Country:US
Mailing Address - Phone:614-488-6285
Mailing Address - Fax:614-488-9592
Practice Address - Street 1:1334 SHERIDAN DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-3956
Practice Address - Country:US
Practice Address - Phone:740-653-9186
Practice Address - Fax:740-653-9214
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.09002101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical