Healthcare Provider Details

I. General information

NPI: 1508364217
Provider Name (Legal Business Name): JOSHUA GRANT VAAL MSW, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2018
Last Update Date: 01/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1146 WASHINGTON SQ
EVANSVILLE IN
47715-6809
US

IV. Provider business mailing address

4404 WETHERSFIELD DR
EVANSVILLE IN
47725-8700
US

V. Phone/Fax

Practice location:
  • Phone: 812-425-2662
  • Fax:
Mailing address:
  • Phone: 812-453-4202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34007889A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: