MEDICARE: MRS. SARAH KATHERINE-BRACKIN ZELL LISW-CP

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	104100000X	Social Worker
2	1041C0700X	Clinical Social Worker	15959	SC

General Provider Information

NPI Number	:	1699464602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SARAH KATHERINE-BRACKIN ZELL LISW-CP

Provider Business Mailing Address
First Line	:	301 KELLWOOD WAY
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29229-7578
Country	:	US
Telephone Number	:	803-348-8282
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 KELLWOOD WAY
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29229-7578
Country	:	US
Telephone Number	:	803-348-8282
Fax Number	:	803-381-9285

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

Provider Enumeration Date	:	05/04/2023
Last Update Date	:	03/19/2024

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