MEDICARE: MRS. HANNAH FU LYNN ACSW LISW

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	00117	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	38713	OTHER	IA	WELLMARK
3	192633	OTHER	CA	MHN PIN #
4	192633	OTHER	NY	MHN PIN #

General Provider Information

NPI Number	:	1669439394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HANNAH FU LYNN ACSW LISW

Provider Business Mailing Address
First Line	:	2327 70TH STREET
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50322-4825
Country	:	US
Telephone Number	:	515-270-1344
Fax Number	:	515-270-6515

Provider Business Practice Location Address
First Line	:	2327 70TH STREET
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50322-4825
Country	:	US
Telephone Number	:	515-270-1344
Fax Number	:	515-270-6515

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

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	07/08/2007

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