MEDICARE: MS. NANCY SCROGHAM GEROW M.S.

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	106H00000X	Marriage & Family Therapist	35000667A	IN

General Provider Information

NPI Number	:	1992912471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NANCY SCROGHAM GEROW M.S.

Provider Business Mailing Address
First Line	:	3421 E STATE BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46805-4830
Country	:	US
Telephone Number	:	260-482-8427
Fax Number	:	260-482-8429

Provider Business Practice Location Address
First Line	:	3421 E STATE BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46805-4830
Country	:	US
Telephone Number	:	260-482-8427
Fax Number	:	260-482-8429

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

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	07/08/2007

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