Provider Demographics
NPI:1124284930
Name:SWEENEY, ALDENA K (LCDCIII)
Entity type:Individual
Prefix:
First Name:ALDENA
Middle Name:K
Last Name:SWEENEY
Suffix:
Gender:F
Credentials:LCDCIII
Other - Prefix:
Other - First Name:ALDENA
Other - Middle Name:K
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:511 PERRY ST
Mailing Address - Street 2:
Mailing Address - City:DEFIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:43512-2123
Mailing Address - Country:US
Mailing Address - Phone:419-782-9920
Mailing Address - Fax:419-784-2523
Practice Address - Street 1:900 W SOUTH BOUNDARY ST BLDG 6
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-5235
Practice Address - Country:US
Practice Address - Phone:614-339-0806
Practice Address - Fax:419-784-2523
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-31
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171M00000X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2910854Medicaid