MEDICARE: MS. SALLY ANN HARGER L.C.S.W.

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	12427	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	120336	OTHER	TX	INDIVIDUAL PROVIDER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	460687000	OTHER	TX	INDIVIDUAL PROVIDER

General Provider Information

NPI Number	:	1700927761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SALLY ANN HARGER L.C.S.W.

Provider Business Mailing Address
First Line	:	109 MANOR CT N
Second Line	:
City	:	WILLOW PARK
State	:	TX
Zip	:	76087-3002
Country	:	US
Telephone Number	:	817-522-8263
Fax Number	:	817-441-1916

Provider Business Practice Location Address
First Line	:	1506 PENNSYLVANIA AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2027
Country	:	US
Telephone Number	:	817-714-7023
Fax Number	:

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

Provider Enumeration Date	:	02/10/2007
Last Update Date	:	05/07/2018

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