Healthcare Provider Details

I. General information

NPI: 1780614123
Provider Name (Legal Business Name): SUSAN L RUTLEDGE-HEHL LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3131 EXECUTIVE PKWY STE 303
TOLEDO OH
43606-1327
US

IV. Provider business mailing address

3131 EXECUTIVE PKWY STE 303
TOLEDO OH
43606-1327
US

V. Phone/Fax

Practice location:
  • Phone: 419-720-9000
  • Fax: 419-720-9002
Mailing address:
  • Phone: 419-720-9000
  • Fax: 419-720-9002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number10007661
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: