Provider Demographics
NPI:1235644402
Name:COLEMAN, SUSAN (LSWOHIO)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:LSWOHIO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 112
Mailing Address - Street 2:
Mailing Address - City:BYESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43723-0112
Mailing Address - Country:US
Mailing Address - Phone:740-680-1049
Mailing Address - Fax:
Practice Address - Street 1:209 SENECA AVE UNIT 3
Practice Address - Street 2:
Practice Address - City:BYESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43723-1364
Practice Address - Country:US
Practice Address - Phone:740-680-1049
Practice Address - Fax:740-680-1049
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-09
Last Update Date:2017-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.0028415104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker