Individual
LISA M GWALTNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW LCSW
Contact information
Practice address
4001 JOHN ST, EVANSVILLE, IN 47714-0216
(812) 473-3144
(812) 422-7558
Mailing address
415 MULBERRY ST, EVANSVILLE, IN 47713-1230
(812) 423-7791
(812) 422-7558
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34003974A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000181765
ANTHEM
IN
05
—
100240880
—
IN
Enumeration date
08/11/2006
Last updated
04/20/2010
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