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NPI Code Detail

MEDICARE: MS. TRACY MICHELLE SCHURCH LISW

MEDICARE:  MS. TRACY MICHELLE SCHURCH  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
1104100000XSocial WorkerS.1001010-TRNEOH
2104100000XSocial WorkerS.1200598OH
31041C0700XClinical Social WorkerI.1440449OH

General Provider Information

NPI Number : 1659670065
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. TRACY MICHELLE SCHURCH LISW
Provider Business Mailing Address
First Line : 24500 CENTER RIDGE RD
Second Line :
City : CLEVELAND
State : OH
Zip : 44145-5601
Country : US
Telephone Number : 440-899-1300
Fax Number :
Provider Business Practice Location Address
First Line : 24500 CENTER RIDGE RD
Second Line :
City : CLEVELAND
State : OH
Zip : 44145-5601
Country : US
Telephone Number : 440-899-1300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/24/2011
Last Update Date : 09/21/2014

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Directions to “ MS. TRACY MICHELLE SCHURCH LISW” Practice Location

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