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General NPI Number Information
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NPI Number | 1942425558
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Entity Type | Individual
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Provider Name | SUSAN YANCEY WEGELIN LISW
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Gender | Female
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 312 3RD ST
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City | ELYRIA
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State | OH
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Zip | 44035-5618
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Country | US
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Telephone | 440-323-5707
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Fax | 440-323-3016
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Provider Business Mailing Address
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Address Line | 227 MARSEILLES AVE
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City | ELYRIA
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State | OH
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Zip | 44035-4041
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Country | US
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Telephone | 440-365-6960
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Fax | 440-365-3896
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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 | I.0008923
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License Number State | OH
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