MEDICARE: SUSAN CHAPPELL 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	4047-C	NV

General Provider Information

NPI Number	:	1285731182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN CHAPPELL LCSW

Provider Business Mailing Address
First Line	:	PO BOX 2595
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89702-2595
Country	:	US
Telephone Number	:	775-885-0888
Fax Number	:	775-885-0201

Provider Business Practice Location Address
First Line	:	675 FAIRVIEW DR
Second Line	:	SUITE 207
City	:	CARSON CITY
State	:	NV
Zip	:	89701-5402
Country	:	US
Telephone Number	:	775-885-0888
Fax Number	:	775-885-0201

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/08/2007

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