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1407859465

NPI Code Detail

MEDICARE: TRACIE L ANDERSON LCSW

MEDICARE: TRACIE L ANDERSON 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
1	1041C0700X	Clinical Social Worker	34000315A	IN
2	1041C0700X	Clinical Social Worker	807	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	160780	OTHER	IN	MEDICARE GROUP
6	160860	OTHER	IN	MEDICARE GROUP
11	CG3623	OTHER	IN	INDIANA RAILROAD MEDICARE
14	800012510	OTHER	IN	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2767013000	OTHER	KY	PASSPORT ADVANTAGE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	000000056294	OTHER		ANTHEM GROUP
5	2444451000	OTHER	KY	PASSPORT GROUP
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	000000226075	OTHER		ANTHEM
9	264003000	OTHER		BR BUTLER'S MIS
10	50704000	OTHER		MAGELLAN GROUP MIS
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
13	1518960681	OTHER		DR BUTLER'S NPI
15	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
16	94882000	OTHER		MAGELLAN MIS
17	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
18	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407859465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACIE L ANDERSON LCSW

Provider Business Mailing Address
First Line	:	510 SPRING ST
Second Line	:
City	:	JEFFERSONVILLE
State	:	IN
Zip	:	47130-3554
Country	:	US
Telephone Number	:	812-282-1888
Fax Number	:	812-218-9318

Provider Business Practice Location Address
First Line	:	510 SPRING ST
Second Line	:
City	:	JEFFERSONVILLE
State	:	IN
Zip	:	47130-3554
Country	:	US
Telephone Number	:	812-282-1888
Fax Number	:	812-218-9318

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	08/15/2015

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1922001171 — JOY A. ANDERSON LCSW
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Practice Fax: 812-285-8392

1336146422 — STEVEN G GIBSON MD
Practice Location Address:

510 SPRING ST
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1699772731 — LAURA L REDDING LCSW
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1629075742 — HENRY E COMBS L.C.S.W., PH D
Practice Location Address:

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Directions to “ TRACIE L ANDERSON LCSW” Practice Location

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