Healthcare Provider Details

I. General information

NPI: 1659281426
Provider Name (Legal Business Name): ELISABETH FAUSNAUGH ED.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BETSY FAUSNAUGH ED.D.

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1099 PANTHER PRIDE DR
DELTA OH
43515-9373
US

IV. Provider business mailing address

1099 PANTHER PRIDE DR
DELTA OH
43515-9373
US

V. Phone/Fax

Practice location:
  • Phone: 419-822-5630
  • Fax: 419-822-2828
Mailing address:
  • Phone: 419-822-5630
  • Fax: 419-822-2828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberLSP.01463
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: