MEDICARE: STEFANIE FORD WADAMS MS ED

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	171M00000X	Case Manager/Care Coordinator		NY

General Provider Information

NPI Number	:	1215787361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEFANIE FORD WADAMS MS ED

Provider Business Mailing Address
First Line	:	3625 BARROW WOOD LN
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40502-6107
Country	:	US
Telephone Number	:	917-748-3925
Fax Number	:

Provider Business Practice Location Address
First Line	:	3625 BARROW WOOD LN
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40502-6107
Country	:	US
Telephone Number	:	917-748-3925
Fax Number	:

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

Provider Enumeration Date	:	03/22/2024
Last Update Date	:	03/22/2024

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