Provider Demographics
NPI:1396863023
Name:WAYANT, ANNE (LISW)
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:
Last Name:WAYANT
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 1:4131 W STREETSBORO RD
Mailing Address - Street 2:SUITE H
Mailing Address - City:RICHFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44286-9040
Mailing Address - Country:US
Mailing Address - Phone:216-932-5770
Mailing Address - Fax:330-467-1151
Practice Address - Street 1:38039 W SPAULDING ST
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-6110
Practice Address - Country:US
Practice Address - Phone:216-932-5770
Practice Address - Fax:330-467-1151
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-00003651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHWASW09533Medicare ID - Type Unspecified