Healthcare Provider Details

I. General information

NPI: 1730120148
Provider Name (Legal Business Name): LORI A TRUESDELL MSW, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 03/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2364 N US HIGHWAY 35
LA PORTE IN
46350-8380
US

IV. Provider business mailing address

2364 NORTH US HWY 35
LAPORTE IN
46350
US

V. Phone/Fax

Practice location:
  • Phone: 219-267-0567
  • Fax:
Mailing address:
  • Phone: 219-267-0567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW012721L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number34001232A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: