Provider Demographics
NPI:1619351087
Name:KUSON, ELIZABETH (LISW-S)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:KUSON
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:ESHELMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW-S
Mailing Address - Street 1:6322 TRUMBULL RD
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:OH
Mailing Address - Zip Code:44041-9333
Mailing Address - Country:US
Mailing Address - Phone:330-221-5951
Mailing Address - Fax:
Practice Address - Street 1:355 W PROSPECT RD STE 116C
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-5830
Practice Address - Country:US
Practice Address - Phone:330-221-5951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-16
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH16003031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical