Provider Demographics
NPI:1205013596
Name:PINCKLEY WOLPH, CINDY SUE (LSW)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:SUE
Last Name:PINCKLEY WOLPH
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 BARTSON ROAD
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420
Mailing Address - Country:US
Mailing Address - Phone:419-332-5524
Mailing Address - Fax:419-332-7581
Practice Address - Street 1:675 BARTSON ROAD
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420
Practice Address - Country:US
Practice Address - Phone:419-332-5524
Practice Address - Fax:419-332-7581
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.0008153104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHS.1101166OtherLICENSED SOCIAL WORKER