MEDICARE: MRS. LA SHAN SAUNDERS MSW,LISW,LICDC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	ICDC.131112	OH
2	1041C0700X	Clinical Social Worker	I.1302245	OH

General Provider Information

NPI Number	:	1073943619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LA SHAN SAUNDERS MSW,LISW,LICDC

Provider Business Mailing Address
First Line	:	2203 FULTON AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45206-2504
Country	:	US
Telephone Number	:	513-961-4663
Fax Number	:

Provider Business Practice Location Address
First Line	:	2203 FULTON AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45206-2504
Country	:	US
Telephone Number	:	513-961-4663
Fax Number	:

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

Provider Enumeration Date	:	11/18/2013
Last Update Date	:	11/18/2013

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