Healthcare Provider Details

I. General information

NPI: 1811910466
Provider Name (Legal Business Name): AMY LEIGH LOPEZ LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2007 STATE ST
WASHINGTON IN
47501-8505
US

IV. Provider business mailing address

515 BAYOU ST
VINCENNES IN
47591-1034
US

V. Phone/Fax

Practice location:
  • Phone: 812-254-1558
  • Fax: 812-254-8308
Mailing address:
  • Phone: 812-886-6800
  • Fax: 812-886-6809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number33005170A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: