Provider Demographics
NPI:1730365891
Name:O'DONNELL, ELIZABETH ANNE (PHD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ANNE
Last Name:O'DONNELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:24629 DETROIT RD
Mailing Address - Street 2:#8
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-2538
Mailing Address - Country:US
Mailing Address - Phone:440-835-0664
Mailing Address - Fax:440-835-0601
Practice Address - Street 1:24629 DETROIT RD
Practice Address - Street 2:#8
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-2538
Practice Address - Country:US
Practice Address - Phone:440-835-0664
Practice Address - Fax:440-835-0601
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-18
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE 0003905101YM0800X
OH009605225100000X
WI4413 - 024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist