1023290137 NPI number — AIMEE M NIELSEN LCSW

Table of content: AIMEE M NIELSEN LCSW (NPI 1023290137)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023290137 NPI number — AIMEE M NIELSEN LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NIELSEN
Provider First Name:
AIMEE
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
EDMONDS
Provider Other First Name:
AIMEE
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1023290137
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/22/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10765 LANTERN ROAD
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
FISHERS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46038-3597
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-621-4181
Provider Business Mailing Address Fax Number:
317-621-4182

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10765 LANTERN ROAD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
FISHERS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46038-3597
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-621-4181
Provider Business Practice Location Address Fax Number:
317-621-4182
Provider Enumeration Date:
11/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  34005917A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3423806 . This is a "CIGNA" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 682352 . This is a "VALUE OPTIONS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 482619 . This is a "MANAGED HEALTH NETWORK" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000701149 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 9084133 . This is a "AETNA" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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