Provider Demographics
NPI:1932335163
Name:BOHLANDER, ELISABETH K (LISW-SUPV)
Entity type:Individual
Prefix:
First Name:ELISABETH
Middle Name:K
Last Name:BOHLANDER
Suffix:
Gender:F
Credentials:LISW-SUPV
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:K
Other - Last Name:BOHLANDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LISW-SUPV
Mailing Address - Street 1:13201 GRANGER RD STE 8
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-1979
Mailing Address - Country:US
Mailing Address - Phone:216-831-2255
Mailing Address - Fax:
Practice Address - Street 1:13201 GRANGER RD STE 8
Practice Address - Street 2:
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44125-1979
Practice Address - Country:US
Practice Address - Phone:216-831-2255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-02
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.00089291041C0700X
OHI.0008929-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0268768Medicaid