Provider Demographics
NPI:1801900345
Name:WATERFIELD, ELIZABETH ANN (PCC-SUPV)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:ANN
Last Name:WATERFIELD
Suffix:
Gender:F
Credentials:PCC-SUPV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3130 EXECUTIVE PKWY
Mailing Address - Street 2:8TH FLOOR
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-1309
Mailing Address - Country:US
Mailing Address - Phone:419-720-9000
Mailing Address - Fax:
Practice Address - Street 1:3130 EXECUTIVE PKWY
Practice Address - Street 2:8TH FLOOR
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-1309
Practice Address - Country:US
Practice Address - Phone:419-720-9000
Practice Address - Fax:419-720-9002
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0003579101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional