Provider Demographics
NPI:1821245804
Name:LANE-BALDWIN, SUSAN M (LISW)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:M
Last Name:LANE-BALDWIN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 E RIVERVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:NAPOLEON
Mailing Address - State:OH
Mailing Address - Zip Code:43545-9805
Mailing Address - Country:US
Mailing Address - Phone:419-591-3872
Mailing Address - Fax:419-591-3854
Practice Address - Street 1:589 E RIVERVIEW AVE
Practice Address - Street 2:
Practice Address - City:NAPOLEON
Practice Address - State:OH
Practice Address - Zip Code:43545-1865
Practice Address - Country:US
Practice Address - Phone:419-592-0500
Practice Address - Fax:419-592-0561
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHO.00077591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
I.0007759OtherLICENSE NUMBER