MEDICARE: WADE GREGORY ANDERSON L.C.S.W.

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	SW 6185	FL

General Provider Information

NPI Number	:	1154408243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WADE GREGORY ANDERSON L.C.S.W.

Provider Business Mailing Address
First Line	:	1713 EAGLE TRACE BLVD
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34685-3313
Country	:	US
Telephone Number	:	727-492-5608
Fax Number	:	727-784-2209

Provider Business Practice Location Address
First Line	:	1713 EAGLE TRACE BLVD
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34685-3313
Country	:	US
Telephone Number	:	727-492-5608
Fax Number	:	727-784-2209

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	07/08/2007

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