Healthcare Provider Details

I. General information

NPI: 1255244752
Provider Name (Legal Business Name): NATALIE DAVISSON LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 CHERRY ST
JASPER IN
47546-2238
US

IV. Provider business mailing address

1620 CHERRY ST
JASPER IN
47546-2238
US

V. Phone/Fax

Practice location:
  • Phone: 812-772-4485
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number33013189A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: