Provider Demographics
NPI:1447975107
Name:ALMOND, SUSIE (COSMETOLOGIST)
Entity type:Individual
Prefix:MRS
First Name:SUSIE
Middle Name:
Last Name:ALMOND
Suffix:
Gender:F
Credentials:COSMETOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37812 VINE ST STE L
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-6253
Mailing Address - Country:US
Mailing Address - Phone:844-613-1936
Mailing Address - Fax:
Practice Address - Street 1:37812 VINE ST STE L
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-6253
Practice Address - Country:US
Practice Address - Phone:844-613-1936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-05
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOSS222599174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH861838498Medicaid