Healthcare Provider Details

I. General information

NPI: 1962538744
Provider Name (Legal Business Name): JACQUELINE M GASPAROVIC MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 05/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 WALL ST
VALPARAISO IN
46383-2512
US

IV. Provider business mailing address

549 S 15TH ST
CHESTERTON IN
46304-2888
US

V. Phone/Fax

Practice location:
  • Phone: 219-531-3500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: