=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497830228
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAREN ANNE SCHUSTER LISW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2006
-----------------------------------------------------
Last Update Date | 04/26/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 270 STERKEL BLVD
-----------------------------------------------------
City | MANSFIELD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44907-1508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-756-1133
-----------------------------------------------------
Fax | 419-756-6544
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 577 BRAE BURN RD
-----------------------------------------------------
City | MANSFIELD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44907-1913
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-774-9581
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | I.0008654
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------