Provider Demographics
NPI:1487913109
Name:MARINKO, PATTI J (LISW)
Entity type:Individual
Prefix:
First Name:PATTI
Middle Name:J
Last Name:MARINKO
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:PATTI
Other - Middle Name:J
Other - Last Name:RUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5433 STATE ROUTE 113
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:OH
Mailing Address - Zip Code:44811-9708
Mailing Address - Country:US
Mailing Address - Phone:567-256-3451
Mailing Address - Fax:567-256-3451
Practice Address - Street 1:5433 STATE ROUTE 113
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:OH
Practice Address - Zip Code:44811-9708
Practice Address - Country:US
Practice Address - Phone:567-256-3450
Practice Address - Fax:567-256-3451
Is Sole Proprietor?:No
Enumeration Date:2012-05-15
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.0004024104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker