MEDICARE: CHRISTINE LEANN ACKMANN L.C.S.W.

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	3560163501	UT
2	1041C0700X	Clinical Social Worker	5553-C	NV

General Provider Information

NPI Number	:	1689789448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE LEANN ACKMANN L.C.S.W.

Provider Business Mailing Address
First Line	:	FLORENCE MCCLURE CORRECTIONAL CENTER
Second Line	:	4370 SMILEY RD
City	:	LAS VEGAS
State	:	NV
Zip	:	89115
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	FLORENCE MCCLURE CORRECTIONAL CENTER
Second Line	:	4370 SMILEY RD
City	:	LAS VEGAS
State	:	NV
Zip	:	89115
Country	:	US
Telephone Number	:	702-668-7200
Fax Number	:

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

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	11/17/2016

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