Provider Demographics
NPI:1740264787
Name:SPIESMAN, JOHN M (LSW,EDD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:SPIESMAN
Suffix:
Gender:M
Credentials:LSW,EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 42
Mailing Address - Street 2:
Mailing Address - City:THOMPSON
Mailing Address - State:OH
Mailing Address - Zip Code:44086-0042
Mailing Address - Country:US
Mailing Address - Phone:440-474-9727
Mailing Address - Fax:440-474-7424
Practice Address - Street 1:391 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-3309
Practice Address - Country:US
Practice Address - Phone:440-474-9727
Practice Address - Fax:440-474-7424
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-02
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X
OHS 32213104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No104100000XBehavioral Health & Social Service ProvidersSocial Worker