MEDICARE: JEFFREY ROBERT DUGAN LSW

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	99125730A	IN

General Provider Information

NPI Number	:	1205659687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY ROBERT DUGAN LSW

Provider Business Mailing Address
First Line	:	777 S MAIN ST STE 100
Second Line	:
City	:	CLINTON
State	:	IN
Zip	:	47842-2493
Country	:	US
Telephone Number	:	765-828-1003
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 W NATIONAL AVE
Second Line	:
City	:	WEST TERRE HAUTE
State	:	IN
Zip	:	47885-1303
Country	:	US
Telephone Number	:	812-244-1515
Fax Number	:

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

Provider Enumeration Date	:	11/05/2024
Last Update Date	:	11/05/2024

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