Provider Demographics
NPI:1689457665
Name:CLINGER, SUZANNE RENEE (LSW, CDCA)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:RENEE
Last Name:CLINGER
Suffix:
Gender:F
Credentials:LSW, CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1634 SYCAMORE LINE
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-4132
Mailing Address - Country:US
Mailing Address - Phone:234-706-0349
Mailing Address - Fax:
Practice Address - Street 1:304 MADISON ST
Practice Address - Street 2:
Practice Address - City:PORT CLINTON
Practice Address - State:OH
Practice Address - Zip Code:43452-1937
Practice Address - Country:US
Practice Address - Phone:234-706-0349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.2309579104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker