MEDICARE: KAREN WEBB LPN, CDCA

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	CDCA.172469	OH
2	164W00000X	Licensed Practical Nurse	LPN.172220.MEDS-IV	OH

General Provider Information

NPI Number	:	1386271062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN WEBB LPN, CDCA

Provider Business Mailing Address
First Line	:	5737 BIGGER RD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45440-2752
Country	:	US
Telephone Number	:	513-738-7600
Fax Number	:	513-738-7601

Provider Business Practice Location Address
First Line	:	5737 BIGGER RD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45440-2752
Country	:	US
Telephone Number	:	513-738-7600
Fax Number	:	513-738-7601

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

Provider Enumeration Date	:	03/24/2020
Last Update Date	:	03/24/2020

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