MEDICARE: AUDREY SCHWEBEL 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-0015	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	057025	OTHER	OH	VALUE OPTIONS
2	000000116463	OTHER	OH	ANTHEM
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336132125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUDREY SCHWEBEL LISW

Provider Business Mailing Address
First Line	:	1601 MOTOR INN DR
Second Line	:	SUITE #320
City	:	GIRARD
State	:	OH
Zip	:	44420-2420
Country	:	US
Telephone Number	:	330-759-0707
Fax Number	:	330-759-9078

Provider Business Practice Location Address
First Line	:	1601 MOTOR INN DR
Second Line	:	SUITE #320
City	:	GIRARD
State	:	OH
Zip	:	44420-2420
Country	:	US
Telephone Number	:	330-759-0707
Fax Number	:	330-759-9078

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

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	07/08/2007

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Directions to “ AUDREY SCHWEBEL LISW” Practice Location

Language	Start Address	Practice Location

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