Healthcare Provider Details

I. General information

NPI: 1033119060
Provider Name (Legal Business Name): JOAN PALMQUIST WOLFORD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2005
Last Update Date: 05/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 A EAST 90TH DRIVE
MERRILLVILLE IN
46410
US

IV. Provider business mailing address

8400 LOUISIANA STREET
MERRILLVILLE IN
46410
US

V. Phone/Fax

Practice location:
  • Phone: 219-736-9115
  • Fax: 219-736-9131
Mailing address:
  • Phone: 251-975-7192
  • Fax: 219-757-1950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34001253A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: