Provider Demographics
NPI:1497221428
Name:BOELLNER, CATHERINE A (LISW, MSW)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:A
Last Name:BOELLNER
Suffix:
Gender:F
Credentials:LISW, MSW
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:A
Other - Last Name:TOMANSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:840 GIBSON DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43612-3918
Mailing Address - Country:US
Mailing Address - Phone:419-779-5982
Mailing Address - Fax:
Practice Address - Street 1:4159 N HOLLAND SYLVANIA RD STE 205
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4801
Practice Address - Country:US
Practice Address - Phone:419-517-6564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-17
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.2203678101YM0800X, 1041C0700X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health