Healthcare Provider Details

I. General information

NPI: 1467410951
Provider Name (Legal Business Name): ROGER L OUTCALT MSW, ACSW, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4715 W 116TH ST
ZIONSVILLE IN
46077-9311
US

IV. Provider business mailing address

10565 NASSAU ST
INDIANAPOLIS IN
46234-3182
US

V. Phone/Fax

Practice location:
  • Phone: 317-873-8140
  • Fax:
Mailing address:
  • Phone: 317-852-5065
  • Fax: 317-852-5096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: