Healthcare Provider Details

I. General information

NPI: 1639664121
Provider Name (Legal Business Name): REBECCA ALYSSA DUNN CREMEANS LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2018
Last Update Date: 06/02/2021
Certification Date: 06/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1451 LUCAS RD
MANSFIELD OH
44903-8682
US

IV. Provider business mailing address

1451 LUCAS RD
MANSFIELD OH
44903-8682
US

V. Phone/Fax

Practice location:
  • Phone: 419-589-5511
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberS.2001488-TRNE
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2106237
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: