Individual provider Active NPI

Fonda Renee Board Asbury, LCSW

  • Clinical Social Worker
  • Terre Haute, IN
National Provider Identifier
1083552590
Registry record updated Jul 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
34012758A Issued in IN
Practice address
620 8TH Ave
Terre Haute, IN 47804-2771
Phone
(812) 231-8323
NPI assigned
Mar 24, 2026
Last updated
Jul 16, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 34012758A IN Primary

Addresses

Primary practice location

620 8TH Ave
Terre Haute, IN 47804-2771

Mailing address

620 8TH Ave
Terre Haute, IN 47804-2771
Phone (812) 231-8242

Other practice location 1

PO Box 406
Clinton, IN 47842-0406
Phone (765) 832-2436

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260401002045 IN Practitioner - Clinical Social Worker 9335624857 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hamilton Center, Inc.Group PAC ID 4284533662, 42 clinicians

Practice addresses (Care Compare)

620 8TH Ave
Terre Haute, IN 47804-2744
Phone (812) 231-8323

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
34012758AINMDClinical Social Worker

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1774310400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784160000000",
    "number": "1083552590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 8TH AVE",
            "city": "TERRE HAUTE",
            "state": "IN",
            "postal_code": "478042771",
            "telephone_number": "812-231-8242",
            "fax_number": "812-954-0127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 8TH AVE",
            "city": "TERRE HAUTE",
            "state": "IN",
            "postal_code": "478042771",
            "telephone_number": "812-231-8323"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "PO Box 406",
            "address_purpose": "LOCATION",
            "city": "Clinton",
            "state": "IN",
            "postal_code": "478420406",
            "country_code": "US",
            "telephone_number": "765-832-2436",
            "fax_number": "765-240-1498",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOARD ASBURY",
        "first_name": "FONDA RENEE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-03-24",
        "last_updated": "2026-07-16",
        "certification_date": "2026-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34012758A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Terre Haute, IN

Sources for this page

Verify at the official NPI Registry.