Provider Demographics
NPI:1477599447
Name:WIZA, SHARON ANN (MSW)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:ANN
Last Name:WIZA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20325 CENTER RIDGE RD
Mailing Address - Street 2:SUITE 628
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-3572
Mailing Address - Country:US
Mailing Address - Phone:440-331-5570
Mailing Address - Fax:440-331-3221
Practice Address - Street 1:20325 CENTER RIDGE RD
Practice Address - Street 2:SUITE 628
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-3572
Practice Address - Country:US
Practice Address - Phone:440-331-5570
Practice Address - Fax:440-331-3221
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI000030431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHWISW09541Medicare ID - Type UnspecifiedSOCIAL WORKER