Healthcare Provider Details

I. General information

NPI: 1730256819
Provider Name (Legal Business Name): NANCY JANE DAVIS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

468 N WOODLAND HEIGHTS DR
CRAWFORDSVILLE IN
47933
US

IV. Provider business mailing address

PO BOX 631
CRAWFORDSVILLE IN
47933
US

V. Phone/Fax

Practice location:
  • Phone: 765-362-4800
  • Fax:
Mailing address:
  • Phone: 765-362-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34000492A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: