MEDICARE: LANETTE SYVERSON MSW, CSW

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

General Provider Information

NPI Number	:	1215472964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LANETTE SYVERSON MSW, CSW

Provider Business Mailing Address
First Line	:	438 WASHINGTON ST
Second Line	:
City	:	STANTON
State	:	KY
Zip	:	40380-2048
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	438 WASHINGTON ST
Second Line	:
City	:	STANTON
State	:	KY
Zip	:	40380-2048
Country	:	US
Telephone Number	:	606-663-2274
Fax Number	:

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

Provider Enumeration Date	:	01/04/2017
Last Update Date	:	01/04/2017

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