Healthcare Provider Details

I. General information

NPI: 1922179977
Provider Name (Legal Business Name): JOHN W. EWING LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5610 CRAWFORDSVILLE RD SUITE 22
INDIANAPOLIS IN
46224-3727
US

IV. Provider business mailing address

5219 E. 200 SOUTH CO. ROAD
AVON IN
46123
US

V. Phone/Fax

Practice location:
  • Phone: 317-244-2243
  • Fax: 317-243-2328
Mailing address:
  • Phone: 317-838-9777
  • Fax: 317-838-9777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34000584A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: