Healthcare Provider Details

I. General information

NPI: 1811065022
Provider Name (Legal Business Name): JANETTE BELUE-WILSON MSW, ACSW, LCSW,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 01/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7125 E US HIGHWAY 36
AVON IN
46123-7968
US

IV. Provider business mailing address

7125 E US HIGHWAY 36
AVON IN
46123-7968
US

V. Phone/Fax

Practice location:
  • Phone: 317-272-2190
  • Fax: 317-272-2199
Mailing address:
  • Phone: 317-272-2190
  • Fax: 317-272-2199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34001449A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: