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NPI Code Detail

MEDICARE: CHASE SULLIVAN LISW

MEDICARE: CHASE SULLIVAN 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
11041C0700XClinical Social WorkerI.1450747OH

General Provider Information

NPI Number : 1528427507
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHASE SULLIVAN LISW
Provider Business Mailing Address
First Line : 799 S MAIN ST
Second Line :
City : LIMA
State : OH
Zip : 45804-1519
Country : US
Telephone Number : 419-229-2222
Fax Number : 419-229-2227
Provider Business Practice Location Address
First Line : 5982 RHODES RD
Second Line :
City : KENT
State : OH
Zip : 44240-8100
Country : US
Telephone Number : 330-673-1347
Fax Number : 330-678-3677
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/18/2016
Last Update Date : 02/18/2016

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Directions to “ CHASE SULLIVAN LISW” Practice Location

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