MEDICARE: MEGAN W. SPINKS 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	34004069A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000325002	OTHER	IN	ANTHEM PIN
2	476925000	OTHER	IN	MAGELLAN
3	4344040	OTHER	IN	CIGNA
4	360007	OTHER	IN	MHN
5	7170222	OTHER	IN	AETNA

General Provider Information

NPI Number	:	1912913336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN W. SPINKS LCSW

Provider Business Mailing Address
First Line	:	6530 CONSTITUTION DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-1550
Country	:	US
Telephone Number	:	260-459-0990
Fax Number	:	260-459-0852

Provider Business Practice Location Address
First Line	:	6530 CONSTITUTION DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-1550
Country	:	US
Telephone Number	:	260-459-0990
Fax Number	:	260-459-0852

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

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	07/08/2007

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