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General NPI Number Information
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NPI Number | 1720809817
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Entity Type | Individual
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Provider Name | CIERA ELIZABETH TRAYLOR LSW
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Gender | Female
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Dates
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Enumeration Date | 10/21/2024
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 3903 INDIANAPOLIS BLVD
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City | EAST CHICAGO
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State | IN
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Zip | 46312-2555
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Country | US
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Telephone | 219-392-6029
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Fax |
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Provider Business Mailing Address
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Address Line | 3903 INDIANAPOLIS BLVD
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City | EAST CHICAGO
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State | IN
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Zip | 46312-2555
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Country | US
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Telephone | 219-769-4005
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Fax | 219-392-6998
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 33012373A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 150113546
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License Number State | IL
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