MEDICARE: MS. SANDRA THOMAS MSW

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	101Y00000X	Counselor
2	104100000X	Social Worker

General Provider Information

NPI Number	:	1710120753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SANDRA THOMAS MSW

Provider Business Mailing Address
First Line	:	5440 THORNBRIAR LN
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46835-3886
Country	:	US
Telephone Number	:	260-484-4600
Fax Number	:	260-484-4002

Provider Business Practice Location Address
First Line	:	5440 THORNBRIAR LN
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46835-3886
Country	:	US
Telephone Number	:	260-484-4600
Fax Number	:	260-484-4002

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

Provider Enumeration Date	:	04/07/2009
Last Update Date	:	04/07/2009

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