Provider Demographics
NPI:1386252146
Name:PICOTT, SUEHELEN GRACE
Entity type:Individual
Prefix:MS
First Name:SUEHELEN
Middle Name:GRACE
Last Name:PICOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2911 STONELEIGH DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43617-1374
Mailing Address - Country:US
Mailing Address - Phone:253-344-8558
Mailing Address - Fax:
Practice Address - Street 1:2911 STONELEIGH DR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43617-1374
Practice Address - Country:US
Practice Address - Phone:253-344-8558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-17
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide