Provider Demographics
NPI:1417139957
Name:STAIB, JOAN L (LISW)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:L
Last Name:STAIB
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 1:315 S. COLLEGE AVE.
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-3254
Mailing Address - Country:US
Mailing Address - Phone:419-352-0702
Mailing Address - Fax:
Practice Address - Street 1:315 S. COLLEGE AVE.
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-3254
Practice Address - Country:US
Practice Address - Phone:419-352-0702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-27
Last Update Date:2008-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI0004462101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH344428225002OtherTRICARE
OHIOOO4462OtherSTATE LICENSE
OHSWO8401Medicare PIN