MEDICARE: MRS. LANA C. SAKASH 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	I-0008652	OH

General Provider Information

NPI Number	:	1184772261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LANA C. SAKASH LISW

Provider Business Mailing Address
First Line	:	102 S SANDUSKY AVE
Second Line	:
City	:	UPPER SANDUSKY
State	:	OH
Zip	:	43351-1424
Country	:	US
Telephone Number	:	419-294-1212
Fax Number	:	419-294-6336

Provider Business Practice Location Address
First Line	:	102 S SANDUSKY AVE
Second Line	:
City	:	UPPER SANDUSKY
State	:	OH
Zip	:	43351-1424
Country	:	US
Telephone Number	:	419-294-1212
Fax Number	:	419-294-6336

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

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	07/08/2007

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