Provider Demographics
NPI:1609831585
Name:STORLIE, CHAD (LISW-S)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:STORLIE
Suffix:
Gender:M
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 E ERIE ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-3513
Mailing Address - Country:US
Mailing Address - Phone:330-541-6746
Mailing Address - Fax:
Practice Address - Street 1:155 E ERIE ST
Practice Address - Street 2:SUITE 301
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-3513
Practice Address - Country:US
Practice Address - Phone:330-541-6746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.1303241-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0226672Medicaid
ILK29994Medicare PIN
5699729OtherFIRST HEALTH
IL9430190OtherPHCS