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General NPI Number Information
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NPI Number | 1740934520
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Entity Type | Individual
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Provider Name | YESSICA NAYELI LAWSON GONZALEZ
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Gender | Female
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Dates
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Enumeration Date | 02/09/2022
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Last Update Date | 02/09/2022
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Provider Practice Location Address
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Address Line | 240 WATERFALL DR
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City | ELKHART
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State | IN
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Zip | 46516-3668
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Country | US
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Telephone | 574-222-6514
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Fax |
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Provider Business Mailing Address
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Address Line | 50832 ACORN TRL
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City | ELKHART
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State | IN
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Zip | 46514-7730
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Country | US
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Telephone | 574-222-6514
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 33010019A
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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 | 33010019
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License Number State | IN
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