Provider Demographics
NPI:1952378820
Name:SANDWALL, SUSAN MARIE (LISW-S)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:MARIE
Last Name:SANDWALL
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 1:565 MISSOURI AVE
Mailing Address - Street 2:APARTMENT 1
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45226-1120
Mailing Address - Country:US
Mailing Address - Phone:917-776-2991
Mailing Address - Fax:
Practice Address - Street 1:200 MCFARLAND ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202-2615
Practice Address - Country:US
Practice Address - Phone:513-354-5618
Practice Address - Fax:513-345-8559
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI05002071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical