Provider Demographics
NPI:1508016262
Name:CLONCH, SHERYL L (RN, LSW)
Entity Type:Individual
Prefix:
First Name:SHERYL
Middle Name:L
Last Name:CLONCH
Suffix:
Gender:F
Credentials:RN, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4777 LOGAN THORNVILLE RD NE
Mailing Address - Street 2:P.O. BOX 238
Mailing Address - City:RUSHVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43150-9751
Mailing Address - Country:US
Mailing Address - Phone:740-536-7905
Mailing Address - Fax:
Practice Address - Street 1:4777 LOGAN THORNVILLE RD NE
Practice Address - Street 2:
Practice Address - City:RUSHVILLE
Practice Address - State:OH
Practice Address - Zip Code:43150-9751
Practice Address - Country:US
Practice Address - Phone:740-536-7905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS 00104631041C0700X
OHRN 342238163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical