Healthcare Provider Details

I. General information

NPI: 1285249003
Provider Name (Legal Business Name): MELISSA ANDERSON WILSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2020
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16372 MAN OWAR LN
WESTFIELD IN
46074-4800
US

IV. Provider business mailing address

8424 NAAB RD STE 1H
INDIANAPOLIS IN
46260-1954
US

V. Phone/Fax

Practice location:
  • Phone: 317-902-1156
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34006721A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: