MEDICARE: GREGORY S. LINK MSW, 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	2004036755	MO

General Provider Information

NPI Number	:	1417923582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY S. LINK MSW, LCSW

Provider Business Mailing Address
First Line	:	PO BOX 19
Second Line	:
City	:	HERMANN
State	:	MO
Zip	:	65041-0019
Country	:	US
Telephone Number	:	573-486-1193
Fax Number	:	573-486-0910

Provider Business Practice Location Address
First Line	:	504 N STURGEON ST
Second Line	:
City	:	MONTGOMERY CITY
State	:	MO
Zip	:	63361-1829
Country	:	US
Telephone Number	:	573-564-2990
Fax Number	:	573-564-2963

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

Provider Enumeration Date	:	02/27/2006
Last Update Date	:	07/08/2007

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