Individual
DR. DIANA LYNN THEISS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D., LISW-S
Contact information
Practice address
5800 MONROE ST STE A1, SYLVANIA, OH 43560-2208
(419) 276-3556
Mailing address
5800 MONROE ST STE A1, SYLVANIA, OH 43560-2208
(419) 276-3556
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
I.0900183-SUPV
OH
1041C0700X
Clinical Social Worker
Primary
I-0900183-SUPV
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0155198
—
OH
Enumeration date
04/17/2011
Last updated
03/02/2023
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