Provider Demographics
NPI:1376876680
Name:FEEZLE, THERESA L (SW)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:L
Last Name:FEEZLE
Suffix:
Gender:F
Credentials:SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:347 MIDWAY BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-9006
Mailing Address - Country:US
Mailing Address - Phone:440-324-4980
Mailing Address - Fax:440-324-4987
Practice Address - Street 1:21 E STATE ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-4281
Practice Address - Country:US
Practice Address - Phone:574-546-1999
Practice Address - Fax:574-546-1900
Is Sole Proprietor?:No
Enumeration Date:2009-09-18
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.0600443104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0268768Medicaid