MEDICARE: STEVEN WHAM 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	0897	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	34006684A	OTHER	IN	IN LICENSE
2	897	OTHER	KY	KY LICENSE

General Provider Information

NPI Number	:	1558304741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN WHAM LCSW

Provider Business Mailing Address
First Line	:	6221 EAST PHYSICIANS CT
Second Line	:	SUITE 2
City	:	EVANSVILLE
State	:	IN
Zip	:	47715
Country	:	US
Telephone Number	:	812-491-7739
Fax Number	:	812-491-8095

Provider Business Practice Location Address
First Line	:	6221 PHYSICIANS CT
Second Line	:	SUITE 2
City	:	EVANSVILLE
State	:	IN
Zip	:	47715-4031
Country	:	US
Telephone Number	:	812-491-7739
Fax Number	:	812-491-8095

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

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	06/30/2014

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Directions to “ STEVEN WHAM LCSW” Practice Location

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