Provider Demographics
NPI:1902414824
Name:BRADSHAW, SUZANNE C (LSW)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:C
Last Name:BRADSHAW
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 1:1501 MAC DR APT 6
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-1361
Mailing Address - Country:US
Mailing Address - Phone:330-396-6627
Mailing Address - Fax:
Practice Address - Street 1:4942 HIGBEE AVE NW STE CANDD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2554
Practice Address - Country:US
Practice Address - Phone:330-491-4331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-16
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.2005121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker