MEDICARE: ALISON PAIGE CLINGENPEEL MA

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	39002379A	IN

General Provider Information

NPI Number	:	1861748212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISON PAIGE CLINGENPEEL MA

Provider Business Mailing Address
First Line	:	7400 E STATE BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-6502
Country	:	US
Telephone Number	:	260-493-0055
Fax Number	:	260-493-2051

Provider Business Practice Location Address
First Line	:	7407 TURKEY RUN DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-7774
Country	:	US
Telephone Number	:	260-493-0055
Fax Number	:	260-493-2051

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

Provider Enumeration Date	:	08/02/2012
Last Update Date	:	08/02/2012

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