Provider Demographics
NPI:1083939953
Name:VERMILLION, ANNE MATHES (LSW)
Entity Type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:MATHES
Last Name:VERMILLION
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:MISS
Other - First Name:ANNE
Other - Middle Name:LOUISE
Other - Last Name:MATHES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:788 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907-1921
Mailing Address - Country:US
Mailing Address - Phone:419-756-2828
Mailing Address - Fax:419-756-9913
Practice Address - Street 1:788 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907-1921
Practice Address - Country:US
Practice Address - Phone:419-756-2828
Practice Address - Fax:419-756-9913
Is Sole Proprietor?:No
Enumeration Date:2010-04-02
Last Update Date:2010-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1000136104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker