Healthcare Provider Details

I. General information

NPI: 1093331118
Provider Name (Legal Business Name): KATHRINE MICHELLE WRIGHT LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2020
Last Update Date: 06/24/2020
Certification Date: 06/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 WILLOW ST
VINCENNES IN
47591-1064
US

IV. Provider business mailing address

545 WILLOW ST
VINCENNES IN
47591-1064
US

V. Phone/Fax

Practice location:
  • Phone: 812-882-0509
  • Fax: 812-895-0585
Mailing address:
  • Phone: 812-882-0509
  • Fax: 812-895-0585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number99099115A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: