Basic Information
| Provider Information | |||||||||
| NPI: | 1770776718 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FAMILY SERVICE OF NORTHWEST OHIO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7320 STATE HIGHWAY 108 | ||||||||
| Address2: | SUITE A | ||||||||
| City: | WAUSEON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435678200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193353732 | ||||||||
| FaxNumber: | 4193353462 | ||||||||
| Practice Location | |||||||||
| Address1: | 7320 STATE HIGHWAY 108 | ||||||||
| Address2: | SUITE A | ||||||||
| City: | WAUSEON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435678200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193353732 | ||||||||
| FaxNumber: | 4193353462 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2007 | ||||||||
| LastUpdateDate: | 08/23/2007 | ||||||||
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| AuthorizedOfficialLastName: | KARAMOL | ||||||||
| AuthorizedOfficialFirstName: | JEANNE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | SUPPORT STAFF SUPERVISOR | ||||||||
| AuthorizedOfficialTelephone: | 4193353732 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 0008698 | OH | Y | Agencies | Community/Behavioral Health |
No ID Information.