MEDICARE: ANDREW STOVER 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	104100000X	Social Worker	6588-M	AR
2	1041C0700X	Clinical Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942564182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW STOVER LCSW

Provider Business Mailing Address
First Line	:	900 S 52ND ST
Second Line	:	200
City	:	ROGERS
State	:	AR
Zip	:	72758-8637
Country	:	US
Telephone Number	:	479-254-1100
Fax Number	:	479-254-2997

Provider Business Practice Location Address
First Line	:	900 S 52ND ST
Second Line	:	200
City	:	ROGERS
State	:	AR
Zip	:	72758-8637
Country	:	US
Telephone Number	:	479-254-1100
Fax Number	:	479-254-2997

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

Provider Enumeration Date	:	07/03/2012
Last Update Date	:	05/13/2016

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Directions to “ ANDREW STOVER LCSW” Practice Location

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