MEDICARE: SANDY MITCHELL KIMPEL 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	34005176A	IN

General Provider Information

NPI Number	:	1164539813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDY MITCHELL KIMPEL LCSW

Provider Business Mailing Address
First Line	:	1 PLAZA DR
Second Line	:	SUITE 6
City	:	PENDLETON
State	:	IN
Zip	:	46064-8823
Country	:	US
Telephone Number	:	765-778-0380
Fax Number	:	765-778-8328

Provider Business Practice Location Address
First Line	:	1 PLAZA DR
Second Line	:	SUITE 6
City	:	PENDLETON
State	:	IN
Zip	:	46064-8823
Country	:	US
Telephone Number	:	765-778-0380
Fax Number	:	765-778-8328

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

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	07/08/2007

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