MEDICARE: MS. WENDY I WILLIS 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	104100000X	Social Worker	34004562	IN
2	104100000X	Social Worker	1650	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	160860U	OTHER	IN	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477559334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. WENDY I WILLIS LCSW

Provider Business Mailing Address
First Line	:	PO BOX 413
Second Line	:
City	:	NEW ALBANY
State	:	IN
Zip	:	47151-0413
Country	:	US
Telephone Number	:	812-206-3291
Fax Number	:	812-206-3296

Provider Business Practice Location Address
First Line	:	229 W SPRING ST
Second Line	:
City	:	NEW ALBANY
State	:	IN
Zip	:	47150-3641
Country	:	US
Telephone Number	:	812-206-3291
Fax Number	:	812-206-3296

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

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	07/08/2007

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