Provider Demographics
NPI:1548695752
Name:FERGUSON, KATINA (LISW-S)
Entity type:Individual
Prefix:
First Name:KATINA
Middle Name:
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29085 PEMBROOKE BLVD
Mailing Address - Street 2:
Mailing Address - City:OLMSTED TWP
Mailing Address - State:OH
Mailing Address - Zip Code:44138-8105
Mailing Address - Country:US
Mailing Address - Phone:862-215-3289
Mailing Address - Fax:
Practice Address - Street 1:34055 SOLON RD
Practice Address - Street 2:200
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-2662
Practice Address - Country:US
Practice Address - Phone:440-914-7840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-06
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 10001301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical