Individual
AMANDA GROTHOUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW LCSW
Contact information
Practice address
315 S 3RD ST, BOONVILLE, IN 47601-1723
(812) 897-4776
(812) 422-7558
Mailing address
415 MULBERRY ST, EVANSVILLE, IN 47713-1230
(812) 423-4418
(812) 422-7558
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
Primary
34007179A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000934722
ANTHEM
IN
05
—
100240880
—
IN
01
—
13509497
CAQH
—
01
—
839090013
MEDICARE
IN
Enumeration date
07/10/2013
Last updated
10/09/2015
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