Provider Demographics
NPI:1124694146
Name:KOLOSZAR, EMILY GISELE (LSW)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:GISELE
Last Name:KOLOSZAR
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3222 RALEIGH DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-1854
Mailing Address - Country:US
Mailing Address - Phone:513-739-2224
Mailing Address - Fax:
Practice Address - Street 1:1219 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43604-5836
Practice Address - Country:US
Practice Address - Phone:567-289-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-01
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2106281104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker