Healthcare Provider Details

I. General information

NPI: 1508405424
Provider Name (Legal Business Name): GLYNIS LONNEMANN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2019
Last Update Date: 06/12/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1057 PRITZ AVE
DAYTON OH
45410-2509
US

IV. Provider business mailing address

415 WELLS MILLS DR APT 110
OXFORD OH
45056-2189
US

V. Phone/Fax

Practice location:
  • Phone: 513-444-3803
  • Fax:
Mailing address:
  • Phone: 513-444-3803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2207739
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: