MEDICARE: ELIZABETH SCHWIETERMAN LISW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)	1270727	OH
2	1041C0700X	Clinical Social Worker	I-2002050-SUPV	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366111387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH SCHWIETERMAN LISW

Provider Business Mailing Address
First Line	:	1160 W BROAD ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43222-1352
Country	:	US
Telephone Number	:	614-274-1455
Fax Number	:	614-274-1433

Provider Business Practice Location Address
First Line	:	2820 CLEVELAND AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43224-4410
Country	:	US
Telephone Number	:	614-274-1455
Fax Number	:	614-274-1433

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2021
Last Update Date	:	04/07/2022

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