MEDICARE: KATHERYN ELIZABETH LA GRANGE 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	LSW4057	TN

General Provider Information

NPI Number	:	1134127350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERYN ELIZABETH LA GRANGE LCSW

Provider Business Mailing Address
First Line	:	6350 W ANDREW JOHNSON HWY
Second Line	:
City	:	TALBOTT
State	:	TN
Zip	:	37877-8605
Country	:	US
Telephone Number	:	800-355-3565
Fax Number	:	423-714-2355

Provider Business Practice Location Address
First Line	:	2018 WESTERN AVE
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37921
Country	:	US
Telephone Number	:	865-544-0406
Fax Number	:	865-544-0480

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

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	11/21/2018

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