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General NPI Number Information
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NPI Number | 1235644402
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Entity Type | Individual
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Provider Name | SUSAN COLEMAN LSWOHIO
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Gender | Female
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Dates
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Enumeration Date | 12/09/2017
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Last Update Date | 12/09/2017
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Provider Practice Location Address
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Address Line | 209 SENECA AVE UNIT 3
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City | BYESVILLE
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State | OH
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Zip | 43723-1364
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Country | US
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Telephone | 740-680-1049
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Fax | 740-680-1049
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Provider Business Mailing Address
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Address Line | PO BOX 112
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City | BYESVILLE
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State | OH
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Zip | 43723-0112
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Country | US
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Telephone | 740-680-1049
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | S.0028415
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License Number State | OH
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