MEDICARE: LAURA ANN WEST LSW

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	104100000X	Social Worker	33010727A	IN

General Provider Information

NPI Number	:	1477264216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA ANN WEST LSW

Provider Business Mailing Address
First Line	:	1101 NOTTINGHILL DR APT 1H
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46234-4019
Country	:	US
Telephone Number	:	317-213-1635
Fax Number	:

Provider Business Practice Location Address
First Line	:	855 N HIGH SCHOOL RD STE 6
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46214-5702
Country	:	US
Telephone Number	:	317-282-3088
Fax Number	:

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

Provider Enumeration Date	:	12/13/2022
Last Update Date	:	12/13/2022

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