Provider Demographics
NPI:1790134583
Name:STREVEL, VERONICA MARY (LSW)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:MARY
Last Name:STREVEL
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:VERONICA
Other - Middle Name:MARY
Other - Last Name:REDCLOUD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:3222 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-2929
Mailing Address - Country:US
Mailing Address - Phone:567-316-7253
Mailing Address - Fax:
Practice Address - Street 1:1 ELIZABETH PL
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-3445
Practice Address - Country:US
Practice Address - Phone:937-952-6811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1601122104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker