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General NPI Number Information
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NPI Number | 1194586511
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Entity Type | Individual
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Provider Name | LAURIE ELAINE ELWELL MSW, LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/22/2024
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Last Update Date | 02/08/2024
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Provider Practice Location Address
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Address Line | 7063 BEN DAVIS DR
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City | MICHIGAN CITY
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State | IN
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Zip | 46360-9138
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Country | US
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Telephone | 219-380-4578
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Fax |
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Provider Business Mailing Address
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Address Line | 7063 BEN DAVIS DR
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City | MICHIGAN CITY
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State | IN
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Zip | 46360-9138
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Country | US
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Telephone | 219-380-4578
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 34005263A
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License Number State | IN
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