1891058350 NPI number — RHONDA SUSANNE CONWAY MSW, LSW

Table of content: RHONDA SUSANNE CONWAY MSW, LSW (NPI 1891058350)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891058350 NPI number — RHONDA SUSANNE CONWAY MSW, LSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CONWAY
Provider First Name:
RHONDA
Provider Middle Name:
SUSANNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW, LSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BAXTER
Provider Other First Name:
RHONDA
Provider Other Middle Name:
SUSANNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW, LSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1891058350
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/11/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15717 SPERRY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VERMILION
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44089-9268
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-387-3368
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6140 S BROADWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LORAIN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44053-3821
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-233-7232
Provider Business Practice Location Address Fax Number:
440-233-9070
Provider Enumeration Date:
06/20/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  I1201076SUPV , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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