MEDICARE: MRS. SUSAN M UEHARA LSW

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	517	HI

General Provider Information

NPI Number	:	1477660686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSAN M UEHARA LSW

Provider Business Mailing Address
First Line	:	41-929 MAHIKU PL
Second Line	:
City	:	WAIMANALO
State	:	HI
Zip	:	96795-1151
Country	:	US
Telephone Number	:	808-449-0175
Fax Number	:

Provider Business Practice Location Address
First Line	:	750 SIGNER BOULEVARD
Second Line	:	BLDG 554
City	:	HICKAM AFB
State	:	HI
Zip	:	96853-5399
Country	:	US
Telephone Number	:	808-449-0175
Fax Number	:

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

Provider Enumeration Date	:	08/24/2006
Last Update Date	:	11/09/2007

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