Provider Demographics
NPI:1770909640
Name:COLLAR, JOAN (LISW-S)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:COLLAR
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16484 STATE ROUTE 189
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS GROVE
Mailing Address - State:OH
Mailing Address - Zip Code:45830-9005
Mailing Address - Country:US
Mailing Address - Phone:419-303-6606
Mailing Address - Fax:
Practice Address - Street 1:2149 COLLINGWOOD BLVD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43620-1652
Practice Address - Country:US
Practice Address - Phone:419-243-9178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-14
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.00087331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical