Provider Demographics
NPI:1134197494
Name:SMITLEY, SUZANNE L (PHD)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:L
Last Name:SMITLEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4841 MONROE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4385
Mailing Address - Country:US
Mailing Address - Phone:419-475-2535
Mailing Address - Fax:419-475-0881
Practice Address - Street 1:4841 MONROE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4385
Practice Address - Country:US
Practice Address - Phone:419-475-2535
Practice Address - Fax:419-475-0881
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3744103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0675014Medicaid
OH0675014Medicaid