Provider Demographics
NPI:1811468085
Name:KING, SASIA N
Entity type:Individual
Prefix:
First Name:SASIA
Middle Name:N
Last Name:KING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SASIA
Other - Middle Name:N
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:830 N. SUMMIT SUITE #2
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1884
Mailing Address - Country:US
Mailing Address - Phone:419-693-9600
Mailing Address - Fax:419-693-6950
Practice Address - Street 1:830 N. SUMMIT SUITE #2
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43604-1884
Practice Address - Country:US
Practice Address - Phone:419-693-9600
Practice Address - Fax:419-693-6950
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0343938Medicaid