Healthcare Provider Details

I. General information

NPI: 1356797443
Provider Name (Legal Business Name): BEVERLY OWUSU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2016
Last Update Date: 05/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 N SUMMIT ST
TOLEDO OH
43604-1884
US

IV. Provider business mailing address

830 N. SUMMIT STREET
TOLEDO OH
43604
US

V. Phone/Fax

Practice location:
  • Phone: 419-693-9600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.1600134
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: