MEDICARE: PHYLLIS D WESTRAY

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	1004	KY
2	104100000X	Social Worker	1004	KY

General Provider Information

NPI Number	:	1205946654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHYLLIS D WESTRAY

Provider Business Mailing Address
First Line	:	2100 GARDINER LN
Second Line	:	SUITE 314
City	:	LOUISVILLE
State	:	KY
Zip	:	40205-2962
Country	:	US
Telephone Number	:	502-473-8547
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 GARDINER LN
Second Line	:	SUITE 314
City	:	LOUISVILLE
State	:	KY
Zip	:	40205-2962
Country	:	US
Telephone Number	:	502-473-8547
Fax Number	:	502-589-8771

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	06/10/2009

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Directions to “ PHYLLIS D WESTRAY ” Practice Location

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