Provider Demographics
NPI:1699214650
Name:DITTES, SUSAN ELAINE (LPC, RN, CDE)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:ELAINE
Last Name:DITTES
Suffix:
Gender:F
Credentials:LPC, RN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2704 SCOTT RD
Mailing Address - Street 2:
Mailing Address - City:SWANTON
Mailing Address - State:OH
Mailing Address - Zip Code:43558-8714
Mailing Address - Country:US
Mailing Address - Phone:419-376-1735
Mailing Address - Fax:
Practice Address - Street 1:2704 SCOTT RD
Practice Address - Street 2:
Practice Address - City:SWANTON
Practice Address - State:OH
Practice Address - Zip Code:43558-8714
Practice Address - Country:US
Practice Address - Phone:419-376-1735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC1500480101YP2500X
OHRN270525163WA2000X, 163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator