Healthcare Provider Details

I. General information

NPI: 1811988132
Provider Name (Legal Business Name): BAMBI L MEYER LCSW, MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BAMBI L ROWAN LCSW, ACSW

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 06/22/2020
Certification Date: 06/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 E WASHINGTON BLVD
FORT WAYNE IN
46802-3210
US

IV. Provider business mailing address

30 W MONROE ST STE 1200
CHICAGO IL
60603-2420
US

V. Phone/Fax

Practice location:
  • Phone: 260-209-7111
  • Fax: 260-222-2835
Mailing address:
  • Phone: 312-733-9730
  • Fax: 773-866-8014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34005138A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: