MEDICARE: MRS. IVY LENARZ MSW, 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	2010001174	MO

General Provider Information

NPI Number	:	1992896997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. IVY LENARZ MSW, LCSW

Provider Business Mailing Address
First Line	:	PO BOX 1359
Second Line	:
City	:	AVA
State	:	MO
Zip	:	65608-1359
Country	:	US
Telephone Number	:	417-683-5739
Fax Number	:	417-683-1602

Provider Business Practice Location Address
First Line	:	504 NW 10TH AVE.
Second Line	:
City	:	AVA
State	:	MO
Zip	:	65608-1359
Country	:	US
Telephone Number	:	417-683-5739
Fax Number	:	417-683-1602

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

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	11/15/2013

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