Healthcare Provider Details

I. General information

NPI: 1922123900
Provider Name (Legal Business Name): KELLI ELIZABETH COLEMAN BSW, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLI ELIZABETH SUISHER BSW, LSW

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3645 WARRENSVILLE CENTER RD #246
SHAKER HEIGHTS OH
44122-5247
US

IV. Provider business mailing address

21140 WESTWOOD RD
FAIRVIEW PARK OH
44126-1520
US

V. Phone/Fax

Practice location:
  • Phone: 216-295-7239
  • Fax: 216-295-7240
Mailing address:
  • Phone: 440-356-0074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS0029825
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: