Basic Information
| Provider Information | |||||||||
| NPI: | 1336488162 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SETLAK MICHELLER | ||||||||
| FirstName: | DIANE | ||||||||
| MiddleName: | KATHERINE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LISW-S | ||||||||
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| Mailing Information | |||||||||
| Address1: | 812 BIRUTA ST | ||||||||
| Address2: | |||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443071104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3307627481 | ||||||||
| FaxNumber: | 3307622001 | ||||||||
| Practice Location | |||||||||
| Address1: | 812 BIRUTA ST | ||||||||
| Address2: | |||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443071104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3307627481 | ||||||||
| FaxNumber: | 3307622001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2013 | ||||||||
| LastUpdateDate: | 02/14/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | I004026 | OH | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.