MEDICARE: NONA LYNN PANKONIEN 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	26270	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	26305012	OTHER	KS	BCBS OF KC

General Provider Information

NPI Number	:	1437197951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NONA LYNN PANKONIEN LCSW

Provider Business Mailing Address
First Line	:	6510 GLENMOOR DR
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75043-5931
Country	:	US
Telephone Number	:	214-770-9394
Fax Number	:

Provider Business Practice Location Address
First Line	:	12700 HILLCREST RD
Second Line	:	SUITE 176
City	:	DALLAS
State	:	TX
Zip	:	75230-2033
Country	:	US
Telephone Number	:	972-233-1010
Fax Number	:	214-623-6692

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

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	05/26/2014

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