MEDICARE: MS. SUSAN ANNE WITT LCSW, CADC1

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	03-03-46	OR
2	1041C0700X	Clinical Social Worker	L2419	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649325580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN ANNE WITT LCSW, CADC1

Provider Business Mailing Address
First Line	:	PO BOX 1245
Second Line	:
City	:	HOOD RIVER
State	:	OR
Zip	:	97031-0083
Country	:	US
Telephone Number	:	541-490-5831
Fax Number	:

Provider Business Practice Location Address
First Line	:	702 COLUMBIA ST
Second Line	:
City	:	HOOD RIVER
State	:	OR
Zip	:	97031-1720
Country	:	US
Telephone Number	:	541-490-5831
Fax Number	:

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

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	05/17/2019

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