Provider Demographics
NPI:1184696197
Name:VALLADE, SUSAN EARLY (MSW)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:EARLY
Last Name:VALLADE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 W WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45056-1747
Mailing Address - Country:US
Mailing Address - Phone:513-523-4929
Mailing Address - Fax:513-523-0577
Practice Address - Street 1:33 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:OH
Practice Address - Zip Code:45056-1747
Practice Address - Country:US
Practice Address - Phone:513-523-4929
Practice Address - Fax:513-523-0577
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-0004070101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health