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NPI Code Detail

MEDICARE: CAROLYN HUDDLE LISW

MEDICARE: CAROLYN HUDDLE 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 0004321OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1I 0004321OTHEROHLICENSE

General Provider Information

NPI Number : 1558334391
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAROLYN HUDDLE LISW
Provider Business Mailing Address
First Line : 1621 VALLEY FORGE DR
Second Line :
City : LANCASTER
State : OH
Zip : 43130-1237
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 131 N EWING ST
Second Line : UNIT B
City : LANCASTER
State : OH
Zip : 43130-3383
Country : US
Telephone Number : 740-689-6700
Fax Number : 740-689-6702
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/10/2006
Last Update Date : 07/08/2007

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Directions to “ CAROLYN HUDDLE LISW” Practice Location

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