Healthcare Provider Details

I. General information

NPI: 1770707069
Provider Name (Legal Business Name): JANE ANN HOSIER LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 NO. MADISON AVENUE
ANDERSON IN
46011-3453
US

IV. Provider business mailing address

4416 E 200 S
ANDERSON IN
46017-9728
US

V. Phone/Fax

Practice location:
  • Phone: 765-298-1702
  • Fax:
Mailing address:
  • Phone: 765-378-5084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number33000495A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: