MEDICARE: BREANNA WHITE

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	34012632A	IN

General Provider Information

NPI Number	:	1649951450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BREANNA WHITE

Provider Business Mailing Address
First Line	:	PO BOX 270
Second Line	:
City	:	PAOLI
State	:	IN
Zip	:	47454-0270
Country	:	US
Telephone Number	:	812-723-3944
Fax Number	:	812-723-7989

Provider Business Practice Location Address
First Line	:	8163 W STATE ROAD 56 STE A
Second Line	:
City	:	WEST BADEN SPRINGS
State	:	IN
Zip	:	47469-7706
Country	:	US
Telephone Number	:	812-723-7125
Fax Number	:	812-936-2599

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

Provider Enumeration Date	:	07/26/2023
Last Update Date	:	02/13/2026

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Directions to “ BREANNA WHITE ” Practice Location

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