Amanda Grothouse, MSW LCSW
Individual provider Active NPI Clinical Social Worker · Boonville, IN
NPI 1235570904 · NPPES record last updated Oct 9, 2015
Key facts
- NPI
- 1235570904
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 34007179A (IN)
- Practice address
- 315 S 3Rd St
Boonville, IN 47601-1723 - Phone
- (812) 897-4776
- Fax
- (812) 422-7558
- NPI assigned
- Jul 10, 2013
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34007179A | IN | MD | Clinical Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | |||
| Clinical Social Worker | 1041C0700X | 34007179A | IN | Yes |
Addresses
Primary practice location
315 S 3Rd St
Boonville, IN 47601-1723
Mailing address
415 Mulberry St
Evansville, IN 47713-1230
Phone (812) 423-4418
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 839090013 | Other | IN | MEDICARE |
| 100240880 | Medicaid | IN | |
| 13509497 | Other | CAQH | |
| 000000934722 | Other | IN | ANTHEM |
Other providers in Boonville, IN
- Ashley Goelzhauser
- Shaina Marie Gogel
- Good Samaritan Hospital
- Cathy Jean Gourley
- Dante J Grasso
- Kaitlyn Nicole Halbig
- Cheryl L Hanou
- Charles Mitchell Hayman
- Cynthia Marie Hinds
- Stephanie Hirons
All providers in Boonville, IN · Clinical Social Worker in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 9, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.