Provider Demographics
NPI:1508405424
Name:LONNEMANN, GLYNIS
Entity Type:Individual
Prefix:
First Name:GLYNIS
Middle Name:
Last Name:LONNEMANN
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 1:415 WELLS MILLS DR APT 110
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45056-2189
Mailing Address - Country:US
Mailing Address - Phone:513-444-3803
Mailing Address - Fax:
Practice Address - Street 1:1057 PRITZ AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45410-2509
Practice Address - Country:US
Practice Address - Phone:513-444-3803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-23
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OHS.2207739104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator