Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 5439 | OH |
N | 103T00000X | Psychologist | 5439 | OH |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 933626 | OH |
Y | 103G00000X | Clinical Psychologist | 5439 | OH |
Y | 103TC0700X | Clinical Psychologist | 5439 | OH |
N | 103TP2701X | Group Psychotherapist | OH |
NPI | 1235160870 |
---|---|
Provider Name | Suzanne B Wing |
First Address | Lancaster, OH 43130-8869 |
Second Address | Lancaster, OH 43130-3799 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 12/05/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
262480473027 | CARESOURCE (01) | OH |