Healthcare Provider Details

I. General information

NPI: 1811953953
Provider Name (Legal Business Name): SHERRI D BIDWELL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 06/02/2021
Certification Date: 06/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 W MAIN ST STE 203
GREENWOOD IN
46142-3130
US

IV. Provider business mailing address

460 N VALLEY LN
GREENWOOD IN
46142-3673
US

V. Phone/Fax

Practice location:
  • Phone: 317-279-5165
  • Fax:
Mailing address:
  • Phone: 317-371-9970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34005452A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: