MEDICARE: MS. DEANNE W. ARCHER LMFT, PT

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	106H00000X	Marriage & Family Therapist	000312	IA

General Provider Information

NPI Number	:	1386889202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEANNE W. ARCHER LMFT, PT

Provider Business Mailing Address
First Line	:	1321 2ND AVE S
Second Line	:
City	:	FORT DODGE
State	:	IA
Zip	:	50501-4925
Country	:	US
Telephone Number	:	515-576-4156
Fax Number	:	515-576-6998

Provider Business Practice Location Address
First Line	:	1321 2ND AVE S
Second Line	:
City	:	FORT DODGE
State	:	IA
Zip	:	50501-4925
Country	:	US
Telephone Number	:	515-576-4156
Fax Number	:	515-576-6998

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

Provider Enumeration Date	:	12/05/2008
Last Update Date	:	12/05/2008

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