Provider Demographics
NPI:1376275479
Name:GENSON, ISABELLA A
Entity Type:Individual
Prefix:
First Name:ISABELLA
Middle Name:A
Last Name:GENSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16590 CROSS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-9448
Mailing Address - Country:US
Mailing Address - Phone:419-308-0474
Mailing Address - Fax:
Practice Address - Street 1:5565 AIRPORT HWY STE 100
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-7391
Practice Address - Country:US
Practice Address - Phone:419-720-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health