Healthcare Provider Details

I. General information

NPI: 1508205956
Provider Name (Legal Business Name): JOHANNA SLIVINSKE LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2013
Last Update Date: 06/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8577 E MARKET ST
WARREN OH
44484-2345
US

IV. Provider business mailing address

8577 E MARKET ST
WARREN OH
44484-2345
US

V. Phone/Fax

Practice location:
  • Phone: 330-856-6663
  • Fax: 330-856-1581
Mailing address:
  • Phone: 330-856-6663
  • Fax: 330-856-1581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS 0021987
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: