Healthcare Provider Details

I. General information

NPI: 1326062605
Provider Name (Legal Business Name): JANET UNDERWOOD SUTHERLAND MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 WEST THIRD STREET
DAYTON OH
45428
US

IV. Provider business mailing address

6613 ENESCO CT
ENGLEWOOD OH
45322-3501
US

V. Phone/Fax

Practice location:
  • Phone: 937-268-6511
  • Fax: 937-267-7599
Mailing address:
  • Phone: 937-771-3456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number001965
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: