MEDICARE: MRS. ANN M ARNETT LCSW CADC III

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	L3086	OR

General Provider Information

NPI Number	:	1336185123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANN M ARNETT LCSW CADC III

Provider Business Mailing Address
First Line	:	3750 CHEMAWA RD NE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97305-1119
Country	:	US
Telephone Number	:	503-304-7642
Fax Number	:	503-304-7677

Provider Business Practice Location Address
First Line	:	3750 CHEMAWA RD NE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97305-1119
Country	:	US
Telephone Number	:	503-304-7642
Fax Number	:	503-304-7677

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

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	07/29/2010

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