Healthcare Provider Details

I. General information

NPI: 1528041316
Provider Name (Legal Business Name): SUSAN M YOST LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2005
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2759 PLYMOUTH AVE
COLUMBUS OH
43209-1824
US

IV. Provider business mailing address

2759 PLYMOUTH AVE
COLUMBUS OH
43209-1824
US

V. Phone/Fax

Practice location:
  • Phone: 614-560-9284
  • Fax:
Mailing address:
  • Phone: 614-560-9284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-7412
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: