Provider Demographics
NPI:1891903324
Name:ROBINSON, SUSAN CAROL (LSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:CAROL
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 E WHIPP RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-2105
Mailing Address - Country:US
Mailing Address - Phone:937-657-3997
Mailing Address - Fax:937-291-3435
Practice Address - Street 1:265 E WHIPP RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-2105
Practice Address - Country:US
Practice Address - Phone:937-657-3997
Practice Address - Fax:937-291-3435
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS 0008771174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist