MEDICARE: CASEY NIEMEIER

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	34007090A	IN

General Provider Information

NPI Number	:	1538618236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASEY NIEMEIER

Provider Business Mailing Address
First Line	:	6815 POWDER DR.
Second Line	:
City	:	INDIANA
State	:	IN
Zip	:	46259
Country	:	US
Telephone Number	:	317-253-7387
Fax Number	:	317-253-7388

Provider Business Practice Location Address
First Line	:	6815 POWDER DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46259-7757
Country	:	US
Telephone Number	:	317-253-7387
Fax Number	:	317-253-7388

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

Provider Enumeration Date	:	09/23/2016
Last Update Date	:	09/23/2016

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