Provider Demographics
NPI:1306806971
Name:RAHALL, SUSAN CAROL (LISW)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:CAROL
Last Name:RAHALL
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 MAPLE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-1408
Mailing Address - Country:US
Mailing Address - Phone:513-248-4043
Mailing Address - Fax:
Practice Address - Street 1:4440 GLENESTE WITHAMSVILLE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45245-1318
Practice Address - Country:US
Practice Address - Phone:513-354-5643
Practice Address - Fax:513-753-7930
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH199311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRASW27241Medicare ID - Type Unspecified