Healthcare Provider Details

I. General information

NPI: 1255678835
Provider Name (Legal Business Name): SUE A. DONLON LISW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2013
Last Update Date: 01/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

870 HIGH ST SUITE 207
WORTHINGTON OH
43085-4139
US

IV. Provider business mailing address

PO BOX 85
WORTHINGTON OH
43085-0085
US

V. Phone/Fax

Practice location:
  • Phone: 614-813-6833
  • Fax:
Mailing address:
  • Phone: 614-813-6833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI. 0700431 SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: