MEDICARE: CANCER SERVICES OF ALLEN COUNTY INC.

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1841126257
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CANCER SERVICES OF ALLEN COUNTY INC.

Provider Business Mailing Address
First Line	:	6316 MUTUAL DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-4259
Country	:	US
Telephone Number	:	260-484-9560
Fax Number	:	260-484-9572

Provider Business Practice Location Address
First Line	:	6316 MUTUAL DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-4259
Country	:	US
Telephone Number	:	260-484-9560
Fax Number	:	260-484-9572

Authorized Official
Title or Position	:	CEO
Name	:	MARY SHANKSTER
Credential	:
Telephone Number	:	260-484-9560

Provider Enumeration Date	:	06/23/2026
Last Update Date	:	06/23/2026

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