MEDICARE: MS. CINDY K BASHAW 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-0007417	OH

General Provider Information

NPI Number	:	1356343818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CINDY K BASHAW LISW

Provider Business Mailing Address
First Line	:	2556 BROAD AVE NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44708-2405
Country	:	US
Telephone Number	:	330-639-0395
Fax Number	:	330-639-0395

Provider Business Practice Location Address
First Line	:	2556 BROAD AVE NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44708-2405
Country	:	US
Telephone Number	:	330-639-0395
Fax Number	:	330-639-0395

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

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	07/08/2007

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