MEDICARE: YESSICA NAYELI LAWSON GONZALEZ

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	33010019	IN
2	104100000X	Social Worker	33010019A	IN
3	1041C0700X	Clinical Social Worker	34010758A	IN

General Provider Information

NPI Number	:	1740934520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YESSICA NAYELI LAWSON GONZALEZ

Provider Business Mailing Address
First Line	:	50832 ACORN TRL
Second Line	:
City	:	ELKHART
State	:	IN
Zip	:	46514-7730
Country	:	US
Telephone Number	:	574-222-6514
Fax Number	:

Provider Business Practice Location Address
First Line	:	240 WATERFALL DR
Second Line	:
City	:	ELKHART
State	:	IN
Zip	:	46516-3668
Country	:	US
Telephone Number	:	574-222-6514
Fax Number	:

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

Provider Enumeration Date	:	02/09/2022
Last Update Date	:	06/29/2026

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