MEDICARE: MRS. JAYME ADKINS WASSERSTROM 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	34004718A	IN

General Provider Information

NPI Number	:	1770725996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JAYME ADKINS WASSERSTROM LCSW

Provider Business Mailing Address
First Line	:	2625 OLD VINES DR
Second Line	:
City	:	WESTFIELD
State	:	IN
Zip	:	46074-8533
Country	:	US
Telephone Number	:	317-523-5001
Fax Number	:

Provider Business Practice Location Address
First Line	:	2625 OLD VINES DR
Second Line	:
City	:	WESTFIELD
State	:	IN
Zip	:	46074-8533
Country	:	US
Telephone Number	:	317-523-5001
Fax Number	:

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

Provider Enumeration Date	:	04/02/2009
Last Update Date	:	04/02/2009

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