MEDICARE: CHARLEEN K SCULLEY

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1114237559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLEEN K SCULLEY

Provider Business Mailing Address
First Line	:	17840 CUMBERLAND RD
Second Line	:
City	:	NOBLESVILLE
State	:	IN
Zip	:	46060-5409
Country	:	US
Telephone Number	:	317-574-1254
Fax Number	:	317-574-1230

Provider Business Practice Location Address
First Line	:	2506 WILLOWBROOK PKWY
Second Line	:	SUITE 111
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46205-1542
Country	:	US
Telephone Number	:	317-574-1254
Fax Number	:	317-574-1230

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

Provider Enumeration Date	:	10/19/2010
Last Update Date	:	10/19/2010

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Directions to “ CHARLEEN K SCULLEY ” Practice Location

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