MEDICARE: LAKAN NICHOLLE SHIPPY 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	34012445A	IN

General Provider Information

NPI Number	:	1932058344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAKAN NICHOLLE SHIPPY LCSW

Provider Business Mailing Address
First Line	:	3702 NEW VISION DR BLDG B
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-1703
Country	:	US
Telephone Number	:	260-266-1401
Fax Number	:	260-458-5734

Provider Business Practice Location Address
First Line	:	3702 NEW VISION DR BLDG B
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-1703
Country	:	US
Telephone Number	:	260-266-1401
Fax Number	:	260-458-5734

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

Provider Enumeration Date	:	01/27/2026
Last Update Date	:	01/27/2026

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