MEDICARE: SUZANNE L HEARD 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
1	1041C0700X	Clinical Social Worker	0003743	OH

General Provider Information

NPI Number	:	1699912766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNE L HEARD LISW

Provider Business Mailing Address
First Line	:	14476 E CARROLL BLVD
Second Line	:
City	:	UNIVERSITY HTS
State	:	OH
Zip	:	44118-4669
Country	:	US
Telephone Number	:	216-255-6841
Fax Number	:

Provider Business Practice Location Address
First Line	:	797 E MARKET ST
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44305-2440
Country	:	US
Telephone Number	:	330-434-4514
Fax Number	:

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

Provider Enumeration Date	:	01/12/2009
Last Update Date	:	01/12/2009

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Directions to “ SUZANNE L HEARD LISW” Practice Location

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