MEDICARE: CAROLE SUE ASHENDORF 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	171M00000X	Case Manager/Care Coordinator	27026	TX

General Provider Information

NPI Number	:	1588860043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLE SUE ASHENDORF LCSW

Provider Business Mailing Address
First Line	:	11700 GAINSBOROUGH RD
Second Line	:
City	:	POTOMAC
State	:	MD
Zip	:	20854
Country	:	US
Telephone Number	:	281-216-0940
Fax Number	:	832-565-8808

Provider Business Practice Location Address
First Line	:	1170 ST. JAMES PLACE #111
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77056
Country	:	US
Telephone Number	:	281-216-0940
Fax Number	:	832-565-8808

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

Provider Enumeration Date	:	06/22/2007
Last Update Date	:	08/06/2009

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