MEDICARE: MS. DONNA JEAN SCARBOROUGH 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	646	AK

General Provider Information

NPI Number	:	1679644322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DONNA JEAN SCARBOROUGH LCSW

Provider Business Mailing Address
First Line	:	PO BOX 5323
Second Line	:
City	:	KETCHIKAN
State	:	AK
Zip	:	99901-0323
Country	:	US
Telephone Number	:	907-225-1592
Fax Number	:

Provider Business Practice Location Address
First Line	:	3050 5TH AVE
Second Line	:
City	:	KETCHIKAN
State	:	AK
Zip	:	99901-5773
Country	:	US
Telephone Number	:	907-228-6509
Fax Number	:	907-247-4135

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

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	07/08/2007

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