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NPI Code Detail

MEDICARE: SARAH TKAC LISW-S

MEDICARE: SARAH TKAC LISW-S
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
1101Y00000XCounselorI.2002454OH
2101YA0400XAddiction (Substance Use Disorder) Counselor141186OH

General Provider Information

NPI Number : 1083159560
Entity Type Code : Individual
Provider Name (Legal Business Name) : SARAH TKAC LISW-S
Provider Business Mailing Address
First Line : 21270 LORAIN RD
Second Line :
City : FAIRVIEW PARK
State : OH
Zip : 44126-2121
Country : US
Telephone Number : 440-672-1299
Fax Number :
Provider Business Practice Location Address
First Line : 21270 LORAIN RD
Second Line :
City : FAIRVIEW PARK
State : OH
Zip : 44126-2121
Country : US
Telephone Number : 440-672-1299
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/20/2016
Last Update Date : 02/27/2024

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Directions to “ SARAH TKAC LISW-S” Practice Location

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