| Jaimee Fenwick, LCSW | |
| 
					124 E Main St, Muncie, IN 47305-2839  | |
| (765) 587-7311 | |
| Not Available | 
| Full Name | Jaimee Fenwick | 
|---|---|
| Gender | Female | 
| Speciality | Social Worker - Clinical | 
| Location | 124 E Main St, Muncie, Indiana | 
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1316326168 | NPI | - | NPPES | 
| P01512387 | Other | IN | RAILROAD PTAN | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 34006062A (Indiana) | Primary | 
| Entity Name | Cleanslate Medical Group Of Indiana Llc | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1023464294 PECOS PAC ID: 4880963909 Enrollment ID: O20171023001515  | 
| Mailing Address | Practice Location Address | 
|---|---|
| Jaimee Fenwick, LCSW 124 E Main St, Muncie, IN 47305-2839 Ph: (765) 587-7311  | Jaimee Fenwick, LCSW 124 E Main St, Muncie, IN 47305-2839 Ph: (765) 587-7311  | 
Amy Louise Huelsenbeck, LCSW Clinical Social Worker Medicare: Medicare Enrolled Practice Location: 240 N Tillotson Ave, Muncie, IN 47304 Phone: 866-306-2647  | |
Robert N. Coles Jr., LCSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 240 N Tillotson Ave, Muncie, IN 47304 Phone: 765-288-1928 Fax: 765-741-0340  | |
Samantha Richards, LCSW Clinical Social Worker Medicare: Medicare Enrolled Practice Location: 1200 S Tillotson Opas, Muncie, IN 47304 Phone: 765-288-1790 Fax: 765-212-3497  | |
Sheila Kathryn Lachat, LCSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 240 N Tillotson Ave, Muncie, IN 47304 Phone: 765-288-1928 Fax: 765-741-0340  | |
Erin M Barnes, LCSW Clinical Social Worker Medicare: Accepting Medicare Assignments Practice Location: 3620 W White River Blvd, Muncie, IN 47304 Phone: 765-288-1928 Fax: 765-741-0335  | |
Emily A Williamson, MSW,LCSW Clinical Social Worker Medicare: Medicare Enrolled Practice Location: 3620 W White River Blvd, Muncie, IN 47304 Phone: 765-288-1928 Fax: 765-741-0335  | |
Ms. Erica Kay Godfrey, MSW, LCSW Clinical Social Worker Medicare: Medicare Enrolled Practice Location: 2401 W University Ave, Muncie, IN 47303 Phone: 765-744-2263 Fax: 765-741-1907  |