MEDICARE: ELENA ABIAD SUTHERLAND 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	104100000X	Social Worker	I0002165	OH

General Provider Information

NPI Number	:	1972565349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELENA ABIAD SUTHERLAND LISW

Provider Business Mailing Address
First Line	:	L-3549
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43260-0001
Country	:	US
Telephone Number	:	740-383-7927
Fax Number	:	740-383-7942

Provider Business Practice Location Address
First Line	:	1040 DELAWARE AVE
Second Line	:
City	:	MARION
State	:	OH
Zip	:	43301-1814
Country	:	US
Telephone Number	:	740-383-7910
Fax Number	:	740-375-8129

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

Provider Enumeration Date	:	04/03/2006
Last Update Date	:	11/13/2012

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