Provider Demographics
NPI:1336668235
Name:SCHMIESING, ELLYN (LISW)
Entity Type:Individual
Prefix:
First Name:ELLYN
Middle Name:
Last Name:SCHMIESING
Suffix:
Gender:F
Credentials:LISW
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 81
Mailing Address - Street 2:
Mailing Address - City:FORT LORAMIE
Mailing Address - State:OH
Mailing Address - Zip Code:45845-0081
Mailing Address - Country:US
Mailing Address - Phone:937-726-8653
Mailing Address - Fax:
Practice Address - Street 1:550 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-3047
Practice Address - Country:US
Practice Address - Phone:937-335-7148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-12
Last Update Date:2022-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.2102823104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker