=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700674785
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHELLE ANN ZAREMBA MSW, LSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/29/2025
-----------------------------------------------------
Last Update Date | 04/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 901 PRINCE WILLIAM RD
-----------------------------------------------------
City | DELPHI
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46923-1758
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 765-201-7852
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9007 E 200 S
-----------------------------------------------------
City | LAFAYETTE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47905-9455
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 765-421-3333
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 33012103A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------