Provider Demographics
NPI:1447808167
Name:AYLWARD, SUSAN GAIL
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:GAIL
Last Name:AYLWARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1906 COES POST RUN
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-2021
Mailing Address - Country:US
Mailing Address - Phone:440-241-4520
Mailing Address - Fax:
Practice Address - Street 1:5700 JAYCOX RD
Practice Address - Street 2:
Practice Address - City:NORTH RIDGEVILLE
Practice Address - State:OH
Practice Address - Zip Code:44039-1439
Practice Address - Country:US
Practice Address - Phone:440-327-6767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool