MEDICARE: DENISE VANHORSSEN L.C.S.W.

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
1	1041C0700X	Clinical Social Worker	SW14522	FL
2	1041C0700X	Clinical Social Worker	34005473A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	34005473	OTHER	IN	PROFESSIONAL LICENSE
2	000000582642	OTHER	IN	BLUE SHIELD

General Provider Information

NPI Number	:	1467427658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE VANHORSSEN L.C.S.W.

Provider Business Mailing Address
First Line	:	2068 LUCAS PKWY
Second Line	:
City	:	LOWELL
State	:	IN
Zip	:	46356-2169
Country	:	US
Telephone Number	:	219-690-7025
Fax Number	:

Provider Business Practice Location Address
First Line	:	2068 LUCAS PKWY
Second Line	:
City	:	LOWELL
State	:	IN
Zip	:	46356
Country	:	US
Telephone Number	:	219-690-7025
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	11/21/2019

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Directions to “ DENISE VANHORSSEN L.C.S.W.” Practice Location

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