Individual provider Active NPI

Lou Ann Wilson

  • Clinical Social Worker
  • Lafayette, IN
National Provider Identifier
1194841023
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
34003292A Issued in IN
Practice address
610 Main St
Lafayette, IN 47901-1451
Phone
(765) 423-2638
NPI assigned
Mar 22, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 34003292A IN Primary

Addresses

Primary practice location

610 Main St
Lafayette, IN 47901-1451

Mailing address

610 Main St
Lafayette, IN 47901-1451

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
I20040907000132 IN Practitioner - Clinical Social Worker 0143296780 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Valley Oaks Health IncGroup PAC ID 7315927563, 45 clinicians

Practice addresses (Care Compare)

2323 Ferry St
Lafayette, IN 47904-3054
Phone (765) 447-1312

610 Main St
Lafayette, IN 47901-1451
Phone (765) 423-2638

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
34003292AINMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Valley Oaks Health Inc CurrentSince Jul 16, 2013 Accepting new patients
Valley Oaks Health Inc CurrentSince Jul 16, 2013 Accepting new patients

Locations

415 N 26th St
Ste 201
Lafayette, IN 47904
Phone (765) 446-6535

610 Main St
Lafayette, IN 47901
Phone (765) 423-2638

217 Farabee Dr N
Lafayette, IN 47905
Phone (765) 250-5416

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1174521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1194841023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 MAIN ST",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479011451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 MAIN ST",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479011451",
            "telephone_number": "765-423-2638"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "LOU",
        "middle_name": "ANN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34003292A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lafayette, IN

Sources for this page

Verify at the official NPI Registry.