Provider Demographics
NPI:1831586478
Name:SIDLO, VIRGINIA (LISW)
Entity type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:
Last Name:SIDLO
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:MS
Other - First Name:GINNY
Other - Middle Name:SUE
Other - Last Name:SIDLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LISW
Mailing Address - Street 1:29 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:OH
Mailing Address - Zip Code:44041-1225
Mailing Address - Country:US
Mailing Address - Phone:440-415-7587
Mailing Address - Fax:
Practice Address - Street 1:29 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:OH
Practice Address - Zip Code:44041-1225
Practice Address - Country:US
Practice Address - Phone:440-415-7587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-21
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.00074241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical