Provider Information for 1942637665
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MONDIE GONZALES LISW
Sex: Female
NPI: 1942637665
Last Updated: 2021-08-13
Certification Date: 2021-08-13
Certification Date: 2021-08-13
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1942637665 | ||||||||
| Enumeration Date | 2013-09-27 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 17637 SHURMER RD STRONGSVILLE, OH 44136-6157 United States Phone: 216-210-4041 | Fax: | ||||||||
| Primary Practice Address | 17637 SHURMER RD STRONGSVILLE, OH 44136-6157 United States Phone: 216-210-4041 | Fax: | ||||||||
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