MEDICARE: DEAF ACCESS TO QUALITY LIFE

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

General Provider Information

NPI Number	:	1659995330
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEAF ACCESS TO QUALITY LIFE

Provider Business Mailing Address
First Line	:	1901 ROSEWOOD RD
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30032-7017
Country	:	US
Telephone Number	:	215-987-2730
Fax Number	:

Provider Business Practice Location Address
First Line	:	1901 ROSEWOOD RD
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30032-7017
Country	:	US
Telephone Number	:	215-987-2730
Fax Number	:

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	DR. MAKOTO IKEGAMI I
Credential	:	DSW, LCSW, MSW
Telephone Number	:	215-987-2730

Provider Enumeration Date	:	05/29/2020
Last Update Date	:	12/21/2023

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Directions to “DEAF ACCESS TO QUALITY LIFE ” Practice Location

Language	Start Address	Practice Location

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