Healthcare Provider Details

I. General information

NPI: 1598761173
Provider Name (Legal Business Name): NOELL L ROWAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 12/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 SPRING ST
JEFFERSONVLLE IN
47130-3554
US

IV. Provider business mailing address

510 SPRING ST
JEFFERSONVLLE IN
47130-3554
US

V. Phone/Fax

Practice location:
  • Phone: 812-282-1888
  • Fax: 812-285-8392
Mailing address:
  • Phone: 812-282-1888
  • Fax: 812-285-8392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number34002976A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number1026
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: