MEDICARE: JANE BRUNS 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	3762	HI

General Provider Information

NPI Number	:	1891056180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANE BRUNS LCSW

Provider Business Mailing Address
First Line	:	486 REPLACEMENT AVE
Second Line	:
City	:	FORT LEONARD WOOD
State	:	MO
Zip	:	65473-8865
Country	:	US
Telephone Number	:	573-596-0212
Fax Number	:	573-596-0551

Provider Business Practice Location Address
First Line	:	486 REPLACEMENT AVE
Second Line	:
City	:	FORT LEONARD WOOD
State	:	MO
Zip	:	65473-8865
Country	:	US
Telephone Number	:	573-596-0212
Fax Number	:	573-596-0551

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

Provider Enumeration Date	:	06/03/2012
Last Update Date	:	06/03/2012

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