Healthcare Provider Details

I. General information

NPI: 1568706471
Provider Name (Legal Business Name): HIEDI L KONSOL LISW-S; LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HIEDI L GODFREY LISW-S

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 09/28/2024
Certification Date: 09/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13420 N MERIDIAN ST STE 400
CARMEL IN
46032-1581
US

IV. Provider business mailing address

1909 JAMES ST
NILES OH
44446-3919
US

V. Phone/Fax

Practice location:
  • Phone: 317-573-7050
  • Fax:
Mailing address:
  • Phone: 330-953-9305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI0700053SUPV
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34011204A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: