MEDICARE: HALLIE BETH DURCHSLAG 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	104100000X	Social Worker	0009859	OH

General Provider Information

NPI Number	:	1396063095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HALLIE BETH DURCHSLAG LISW

Provider Business Mailing Address
First Line	:	3109 MAYFIELD RD
Second Line	:	204
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-1726
Country	:	US
Telephone Number	:	216-916-2070
Fax Number	:

Provider Business Practice Location Address
First Line	:	3109 MAYFIELD RD
Second Line	:	204
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-1726
Country	:	US
Telephone Number	:	216-916-2070
Fax Number	:

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

Provider Enumeration Date	:	05/06/2010
Last Update Date	:	10/18/2016

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