Provider Demographics
NPI:1356418883
Name:SUEHRSTEDT, RICHARD (MSW)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:SUEHRSTEDT
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7429 INTERNATIONAL DR
Mailing Address - Street 2:#2
Mailing Address - City:HOLLAND
Mailing Address - State:OH
Mailing Address - Zip Code:43528
Mailing Address - Country:US
Mailing Address - Phone:419-866-8232
Mailing Address - Fax:419-866-8233
Practice Address - Street 1:7429 INTERNATIONAL DR
Practice Address - Street 2:#2
Practice Address - City:HOLLAND
Practice Address - State:OH
Practice Address - Zip Code:43528
Practice Address - Country:US
Practice Address - Phone:419-866-8232
Practice Address - Fax:419-866-8233
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI2161104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7855463OtherAETNA