Provider Demographics
NPI:1780936294
Name:LUTHI FENWICK, CELESTE SUSANNE (LISW)
Entity type:Individual
Prefix:MS
First Name:CELESTE
Middle Name:SUSANNE
Last Name:LUTHI FENWICK
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:MS
Other - First Name:CELESTE
Other - Middle Name:SUSANNE
Other - Last Name:LUTHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1045 KLOTZ RD
Mailing Address - Street 2:P.O. BOX 738
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-4820
Mailing Address - Country:US
Mailing Address - Phone:419-352-7588
Mailing Address - Fax:419-354-4977
Practice Address - Street 1:1045 KLOTZ RD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-4820
Practice Address - Country:US
Practice Address - Phone:419-352-7588
Practice Address - Fax:419-354-4977
Is Sole Proprietor?:No
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 12012421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHI 1201242OtherLISW