Healthcare Provider Details

I. General information

NPI: 1780758128
Provider Name (Legal Business Name): SUSAN LEIGH SNIDER LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 PEARL RD SUITE 206
BRUNSWICK OH
44212-3448
US

IV. Provider business mailing address

1380 PEARL RD SUITE 206
BRUNSWICK OH
44212-3448
US

V. Phone/Fax

Practice location:
  • Phone: 330-220-3611
  • Fax: 330-558-0211
Mailing address:
  • Phone: 330-220-3611
  • Fax: 330-558-0211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI 9081
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: