Provider Demographics
NPI:1700444593
Name:BANNON, ERIN (PHD)
Entity type:Individual
Prefix:DR
First Name:ERIN
Middle Name:
Last Name:BANNON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:BANNON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ERIN BANNON PHD LLC
Mailing Address - Street 1:3014 RIVA RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:OTTAWA HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:43615-2134
Mailing Address - Country:US
Mailing Address - Phone:313-674-0300
Mailing Address - Fax:
Practice Address - Street 1:3150 N REPUBLIC BLVD STE 5
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-1514
Practice Address - Country:US
Practice Address - Phone:419-905-5676
Practice Address - Fax:419-491-0350
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2023-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHP.07961103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty