MEDICARE: STEPHANIE DEXTER

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	34001461A	IN

General Provider Information

NPI Number	:	1669908109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE DEXTER

Provider Business Mailing Address
First Line	:	740 E 52ND ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46205-1172
Country	:	US
Telephone Number	:	317-253-7387
Fax Number	:	317-253-7388

Provider Business Practice Location Address
First Line	:	740 E 52ND ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46205-1172
Country	:	US
Telephone Number	:	317-253-7387
Fax Number	:	317-253-7388

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

Provider Enumeration Date	:	05/03/2017
Last Update Date	:	05/03/2017

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Directions to “ STEPHANIE DEXTER ” Practice Location

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