Individual
DEBRA JEAN AMIDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1930 DOWLING ST, KENDALLVILLE, IN 46755-9436
(260) 347-4400
(260) 347-3122
Mailing address
PO BOX 817, KENDALLVILLE, IN 46755-0817
(260) 347-2453
(260) 347-2456
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34004904A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
34004904A
LICENSE
IN
Enumeration date
01/29/2007
Last updated
01/08/2010
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