MEDICARE: CAROL A JUERGENSEN SHEETS 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	34001957	IN

General Provider Information

NPI Number	:	1952342768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL A JUERGENSEN SHEETS LCSW

Provider Business Mailing Address
First Line	:	950 N MERIDIAN STREET
Second Line	:	SUITE 500
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46204-3908
Country	:	US
Telephone Number	:	317-962-4940
Fax Number	:	317-962-4950

Provider Business Practice Location Address
First Line	:	9670 E WASHINGTON ST
Second Line	:	SUITE 120
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46229-3032
Country	:	US
Telephone Number	:	317-890-5700
Fax Number	:	317-890-5717

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

Provider Enumeration Date	:	06/10/2006
Last Update Date	:	11/18/2010

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