Healthcare Provider Details

I. General information

NPI: 1447808076
Provider Name (Legal Business Name): DENISE DORIS GRASSER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2019
Last Update Date: 12/22/2020
Certification Date: 12/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 TEEGARDEN ST
LA PORTE IN
46350-3175
US

IV. Provider business mailing address

2401 VALLEY DR
VALPARAISO IN
46383-2520
US

V. Phone/Fax

Practice location:
  • Phone: 219-326-0043
  • Fax: 219-326-8909
Mailing address:
  • Phone: 219-413-5100
  • Fax: 219-465-9502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34001773A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: