Provider Demographics
NPI:1891058350
Name:CONWAY, RHONDA SUSANNE (MSW, LSW)
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:SUSANNE
Last Name:CONWAY
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:RHONDA
Other - Middle Name:SUSANNE
Other - Last Name:BAXTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LSW
Mailing Address - Street 1:15717 SPERRY RD
Mailing Address - Street 2:
Mailing Address - City:VERMILION
Mailing Address - State:OH
Mailing Address - Zip Code:44089-9268
Mailing Address - Country:US
Mailing Address - Phone:440-387-3368
Mailing Address - Fax:
Practice Address - Street 1:6140 S BROADWAY
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-3821
Practice Address - Country:US
Practice Address - Phone:440-233-7232
Practice Address - Fax:440-233-9070
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI1201076SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical