Provider Demographics
NPI:1871189894
Name:GOSLAK, SUSAN H
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:H
Last Name:GOSLAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 SOUTHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-1845
Mailing Address - Country:US
Mailing Address - Phone:419-874-3256
Mailing Address - Fax:
Practice Address - Street 1:348 SOUTHWOOD DR
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-1845
Practice Address - Country:US
Practice Address - Phone:419-874-3256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care