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NPI Code Detail

MEDICARE: MS. KANDYCE KRAUS HANNON LCSW

MEDICARE: MS. KANDYCE KRAUS HANNON LCSW
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
11041C0700XClinical Social Worker34002463AIN

General Provider Information

NPI Number : 1396821344
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KANDYCE KRAUS HANNON LCSW
Provider Business Mailing Address
First Line : 8 MORGAN BLVD
Second Line :
City : VALPARAISO
State : IN
Zip : 46383-4836
Country : US
Telephone Number : 219-464-9495
Fax Number : 219-465-7169
Provider Business Practice Location Address
First Line : 8 MORGAN BLVD
Second Line :
City : VALPARAISO
State : IN
Zip : 46383-4836
Country : US
Telephone Number : 219-464-9495
Fax Number : 219-465-7169
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/31/2006
Last Update Date : 07/08/2007

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