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NPI Code Detail

MEDICARE: LANA JEAN SPROUSE MSW, LCSW

MEDICARE: LANA JEAN SPROUSE MSW, 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
11041C0700XClinical Social Worker34004670AIN

General Provider Information

NPI Number : 1346351863
Entity Type Code : Individual
Provider Name (Legal Business Name) : LANA JEAN SPROUSE MSW, LCSW
Provider Business Mailing Address
First Line : 607 SOUTH ST
Second Line :
City : FOUNTAIN CITY
State : IN
Zip : 47341-9446
Country : US
Telephone Number : 765-847-5415
Fax Number :
Provider Business Practice Location Address
First Line : 1401 CHESTER BLVD
Second Line :
City : RICHMOND
State : IN
Zip : 47374-1908
Country : US
Telephone Number : 765-983-3000
Fax Number : 765-983-3210
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2006
Last Update Date : 07/08/2007

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