Individual
EDISON STAWOWY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
326 COUNTY ROAD 119, FREMONT, OH 43420-9384
(419) 689-1865
Mailing address
326 COUNTY ROAD 119, FREMONT, OH 43420-9384
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
06/17/2025
Last updated
06/26/2025
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