MEDICARE: STEPHANIE C CRAIG 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	0000005217	TN

General Provider Information

NPI Number	:	1043541683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE C CRAIG LCSW

Provider Business Mailing Address
First Line	:	650 JOEL DR
Second Line	:
City	:	FORT CAMPBELL
State	:	KY
Zip	:	42223-5349
Country	:	US
Telephone Number	:	270-798-8601
Fax Number	:

Provider Business Practice Location Address
First Line	:	5661 SCREAMING EAGLE BLVD
Second Line	:
City	:	FORT CAMPBELL
State	:	KY
Zip	:	42223-5405
Country	:	US
Telephone Number	:	270-956-3793
Fax Number	:	270-798-5633

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

Provider Enumeration Date	:	01/21/2010
Last Update Date	:	06/20/2018

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