MEDICARE: MRS. MELISSA WARD AMMERMAN LCSW

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	1669	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AMMEMELI	OTHER	KY	HUMANA
2	335566	OTHER	KY	MHN

General Provider Information

NPI Number	:	1104971134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELISSA WARD AMMERMAN LCSW

Provider Business Mailing Address
First Line	:	3150 CUSTER DR
Second Line	:	SUITE 203
City	:	LEXINGTON
State	:	KY
Zip	:	40517-4010
Country	:	US
Telephone Number	:	859-271-7788
Fax Number	:	859-273-3306

Provider Business Practice Location Address
First Line	:	3150 CUSTER DR
Second Line	:	SUITE 203
City	:	LEXINGTON
State	:	KY
Zip	:	40517-4010
Country	:	US
Telephone Number	:	859-271-7788
Fax Number	:	859-273-3306

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

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	07/08/2007

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