MEDICARE: AMY LYNNE NAGAJ LMSW

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	104100000X	Social Worker	6801080214	MI

General Provider Information

NPI Number	:	1255398632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY LYNNE NAGAJ LMSW

Provider Business Mailing Address
First Line	:	2427 SPRING ARBOR RD
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49203-2988
Country	:	US
Telephone Number	:	517-474-4673
Fax Number	:

Provider Business Practice Location Address
First Line	:	2427 SPRING ARBOR RD
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49203-2988
Country	:	US
Telephone Number	:	517-474-4673
Fax Number	:

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

Provider Enumeration Date	:	04/28/2006
Last Update Date	:	07/08/2007

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