MEDICARE: KRISTIN D EVERETT 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
1	1041C0700X	Clinical Social Worker	34010316A	IN

General Provider Information

NPI Number	:	1538943014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN D EVERETT LCSW

Provider Business Mailing Address
First Line	:	6001 N US 31
Second Line	:
City	:	WHITELAND
State	:	IN
Zip	:	46184-9767
Country	:	US
Telephone Number	:	317-882-5122
Fax Number	:

Provider Business Practice Location Address
First Line	:	6001 N US 31
Second Line	:
City	:	WHITELAND
State	:	IN
Zip	:	46184-9767
Country	:	US
Telephone Number	:	317-882-5122
Fax Number	:

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

Provider Enumeration Date	:	08/24/2023
Last Update Date	:	08/24/2023

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Directions to “ KRISTIN D EVERETT LCSW” Practice Location

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