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NPI Code Detail

MEDICARE: MS. TAMARA L VANBAALEN LCSW

MEDICARE: MS. TAMARA L VANBAALEN LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker34003564AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1742863000OTHERINMAGELLAN
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3000000341875OTHERINANTHEM BCBS
4030305OTHERINMHN
57733638OTHERINAETNA

General Provider Information

NPI Number : 1144322777
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. TAMARA L VANBAALEN LCSW
Provider Business Mailing Address
First Line : 11109 PARKVIEW PLAZA DR # 117
Second Line :
City : FORT WAYNE
State : IN
Zip : 46845-1701
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5693 YMCA PARK DR W
Second Line :
City : FORT WAYNE
State : IN
Zip : 46835-3280
Country : US
Telephone Number : 260-425-6500
Fax Number : 260-425-6505
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/03/2006
Last Update Date : 11/16/2021

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