MEDICARE: KEVIN DOBSON 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	34004034	IN

General Provider Information

NPI Number	:	1891753570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN DOBSON LCSW

Provider Business Mailing Address
First Line	:	2901 OHIO BLVD
Second Line	:	SUITE 202
City	:	TERRE HAUTE
State	:	IN
Zip	:	47803-2239
Country	:	US
Telephone Number	:	812-232-2144
Fax Number	:	812-234-4598

Provider Business Practice Location Address
First Line	:	2901 OHIO BLVD
Second Line	:	SUITE 202
City	:	TERRE HAUTE
State	:	IN
Zip	:	47803-2239
Country	:	US
Telephone Number	:	812-232-2144
Fax Number	:	812-234-4598

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

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	03/25/2008

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