MEDICARE: GARY L LEMMON 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	104100000X	Social Worker		IL

General Provider Information

NPI Number	:	1720299811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY L LEMMON LCSW

Provider Business Mailing Address
First Line	:	393 CO. RD. 835 N
Second Line	:
City	:	NORRIS CITY
State	:	IL
Zip	:	62869
Country	:	US
Telephone Number	:	618-378-3805
Fax Number	:

Provider Business Practice Location Address
First Line	:	904 E MAIN ST
Second Line	:
City	:	NORRIS CITY
State	:	IL
Zip	:	62869-1118
Country	:	US
Telephone Number	:	618-378-3010
Fax Number	:	618-378-2308

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

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	07/08/2007

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Directions to “ GARY L LEMMON LCSW” Practice Location

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