Healthcare Provider Details

I. General information

NPI: 1336044429
Provider Name (Legal Business Name): LAUREN M CAMPBELL MSW LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4735 STATESMEN DR STE A
INDIANAPOLIS IN
46250-5647
US

IV. Provider business mailing address

4735 STATESMEN DR STE A
INDIANAPOLIS IN
46250-5647
US

V. Phone/Fax

Practice location:
  • Phone: 317-986-4956
  • Fax: 317-452-8821
Mailing address:
  • Phone: 317-986-4956
  • Fax: 317-452-8821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number33014195A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: