MEDICARE: MR. MICHAEL GREG VANGORDER LMSW

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	06588	IA

General Provider Information

NPI Number	:	1871847780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL GREG VANGORDER LMSW

Provider Business Mailing Address
First Line	:	216 N MAIN ST
Second Line	:
City	:	CHARLES CITY
State	:	IA
Zip	:	50616-2017
Country	:	US
Telephone Number	:	641-228-2050
Fax Number	:

Provider Business Practice Location Address
First Line	:	216 N MAIN ST
Second Line	:
City	:	CHARLES CITY
State	:	IA
Zip	:	50616-2017
Country	:	US
Telephone Number	:	641-228-2050
Fax Number	:

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

Provider Enumeration Date	:	10/30/2012
Last Update Date	:	10/30/2012

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