MEDICARE: KAMI LYNN BOWERSOX 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	1041C0700X	Clinical Social Worker	34009939A	IN
2	1041C0700X	Clinical Social Worker	I.2507095-SUPV	OH
3	1041C0700X	Clinical Social Worker	53884	TX

General Provider Information

NPI Number	:	1699408351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAMI LYNN BOWERSOX LCSW

Provider Business Mailing Address
First Line	:	1474 TURNCOAT CIR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46234-9804
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6330 W 71ST ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46278-1784
Country	:	US
Telephone Number	:	317-280-1319
Fax Number	:

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

Provider Enumeration Date	:	07/08/2022
Last Update Date	:	11/19/2025

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