MEDICARE: MRS. SANDRA LYNN IRWIN

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	1041S0200X	School Social Worker

General Provider Information

NPI Number	:	1730211517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SANDRA LYNN IRWIN

Provider Business Mailing Address
First Line	:	7502 N 39TH AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85051-6417
Country	:	US
Telephone Number	:	602-347-2554
Fax Number	:	602-347-2520

Provider Business Practice Location Address
First Line	:	7502 N 39TH AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85051-6417
Country	:	US
Telephone Number	:	602-347-2554
Fax Number	:	602-347-2520

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

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	07/08/2007

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