Healthcare Provider Details

I. General information

NPI: 1548701212
Provider Name (Legal Business Name): JOEL D FEHSENFELD LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JODIE FEHSENFELD

II. Dates (important events)

Enumeration Date: 03/15/2017
Last Update Date: 03/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 VANN AVE
EVANSVILLE IN
47714-1444
US

IV. Provider business mailing address

PO BOX 33
EVANSVILLE IN
47701-0033
US

V. Phone/Fax

Practice location:
  • Phone: 812-402-8333
  • Fax: 812-402-8331
Mailing address:
  • Phone: 812-473-0181
  • Fax: 812-473-5822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34007435A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: