MEDICARE: SUSAN M YOST 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	1041C0700X	Clinical Social Worker	I-7412	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	235761	OTHER	OH	VALUEOPTIONS

General Provider Information

NPI Number	:	1528041316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN M YOST LISW

Provider Business Mailing Address
First Line	:	2759 PLYMOUTH AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43209-1824
Country	:	US
Telephone Number	:	614-560-9284
Fax Number	:

Provider Business Practice Location Address
First Line	:	2759 PLYMOUTH AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43209-1824
Country	:	US
Telephone Number	:	614-560-9284
Fax Number	:

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

Provider Enumeration Date	:	11/25/2005
Last Update Date	:	01/23/2024

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