MEDICARE: CAROL ELAINE STOGSDILL

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1679228373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL ELAINE STOGSDILL

Provider Business Mailing Address
First Line	:	1515 N POST RD STE A
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-4213
Country	:	US
Telephone Number	:	317-282-3088
Fax Number	:

Provider Business Practice Location Address
First Line	:	855 N HIGH SCHOOL RD STE 6
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46214-5702
Country	:	US
Telephone Number	:	317-282-3088
Fax Number	:

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

Provider Enumeration Date	:	02/21/2022
Last Update Date	:	02/21/2022

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