Provider Demographics
NPI:1548300247
Name:ELDER, JOANN BROWN (MS)
Entity type:Individual
Prefix:MRS
First Name:JOANN
Middle Name:BROWN
Last Name:ELDER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2925
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45401-2925
Mailing Address - Country:US
Mailing Address - Phone:937-277-5855
Mailing Address - Fax:937-279-1225
Practice Address - Street 1:2234 SALEM AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-5627
Practice Address - Country:US
Practice Address - Phone:937-279-1224
Practice Address - Fax:937-279-1225
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS 6051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHELCP22461Medicare ID - Type UnspecifiedMEDICARE