Provider Demographics
NPI:1386701902
Name:ACKERMAN-SPAIN, KAREN ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:ANN
Last Name:ACKERMAN-SPAIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 W. SOUTH BOUNDARY
Mailing Address - Street 2:SUITE MM
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-1784
Mailing Address - Country:US
Mailing Address - Phone:419-873-0891
Mailing Address - Fax:419-873-0892
Practice Address - Street 1:134 W SOUTH BOUNDARY ST
Practice Address - Street 2:SUITE MM
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-1763
Practice Address - Country:US
Practice Address - Phone:419-873-0891
Practice Address - Fax:419-873-0892
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6278103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH181810Medicare PIN