MEDICARE: AMY IKERD MSW LCSW LCAC

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	87000030A	IN
2	1041C0700X	Clinical Social Worker	34006819A	IN

General Provider Information

NPI Number	:	1063814762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY IKERD MSW LCSW LCAC

Provider Business Mailing Address
First Line	:	5660 CAITO DRIVE
Second Line	:	SUITE 120
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46203
Country	:	US
Telephone Number	:	317-755-8050
Fax Number	:

Provider Business Practice Location Address
First Line	:	5660 CAITO DR
Second Line	:	SUITE 120
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46226-1372
Country	:	US
Telephone Number	:	317-755-8050
Fax Number	:

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

Provider Enumeration Date	:	09/24/2014
Last Update Date	:	09/24/2014

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