MEDICARE: MRS. GINGER E WEGNER 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	34001984A	IN

General Provider Information

NPI Number	:	1255307476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GINGER E WEGNER LCSW

Provider Business Mailing Address
First Line	:	7850 W 245TH AVE
Second Line	:
City	:	LOWELL
State	:	IN
Zip	:	46356-9215
Country	:	US
Telephone Number	:	219-552-9020
Fax Number	:	219-552-9020

Provider Business Practice Location Address
First Line	:	1040 E COMMERCIAL AVE
Second Line	:
City	:	LOWELL
State	:	IN
Zip	:	46356-2310
Country	:	US
Telephone Number	:	219-696-3594
Fax Number	:	219-696-3594

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

Provider Enumeration Date	:	02/27/2006
Last Update Date	:	07/08/2007

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