MEDICARE: KEISHA SAVAGE 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
2	1041C0700X	Clinical Social Worker	I.1800860-SUPV	OH

General Provider Information

NPI Number	:	1679044465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEISHA SAVAGE LISW

Provider Business Mailing Address
First Line	:	3279 INDIANOLA AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43202-1364
Country	:	US
Telephone Number	:	614-905-7966
Fax Number	:	614-573-0534

Provider Business Practice Location Address
First Line	:	470 W BROAD ST # 1150
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43215-2759
Country	:	US
Telephone Number	:	614-905-7966
Fax Number	:

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

Provider Enumeration Date	:	12/06/2018
Last Update Date	:	10/11/2024

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