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General NPI Number Information
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NPI Number | 1306806971
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Entity Type | Individual
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Provider Name | SUSAN CAROL RAHALL LISW
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Gender | Female
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Dates
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Enumeration Date | 03/27/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4440 GLENESTE WITHAMSVILLE RD SUITE 100
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City | CINCINNATI
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State | OH
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Zip | 45245-1318
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Country | US
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Telephone | 513-354-5643
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Fax | 513-753-7930
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Provider Business Mailing Address
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Address Line | 707 MAPLE RIDGE RD
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City | MILFORD
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State | OH
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Zip | 45150-1408
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Country | US
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Telephone | 513-248-4043
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 19931
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License Number State | OH
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