Active NPI
Susan Wahlstrom, LCSW
- Clinical Social Worker
- Evansville, IN
National Provider Identifier
1407433733
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 34002263A
- Practice address
- 4001 John St
Evansville, IN 47714-0216 - Phone
- (812) 473-3144
- Fax
- (812) 436-4306
- NPI assigned
- Mar 24, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 34002263A | IN | Primary |
Addresses
Primary practice location
4001 John St
Evansville, IN 47714-0216
Mailing address
415 Mulberry St
Evansville, IN 47713-1230
Phone (812) 423-7791
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34002263A | IN | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1616544000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1616544000000",
"number": "1407433733",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "415 MULBERRY ST",
"city": "EVANSVILLE",
"state": "IN",
"postal_code": "477131230",
"telephone_number": "812-423-7791",
"fax_number": "812-436-4306"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4001 JOHN ST",
"city": "EVANSVILLE",
"state": "IN",
"postal_code": "477140216",
"telephone_number": "812-473-3144",
"fax_number": "812-436-4306"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAHLSTROM",
"first_name": "SUSAN",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-03-24",
"last_updated": "2021-03-24",
"certification_date": "2021-03-24",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IN",
"license": "34002263A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Evansville, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.