Individual
LAWRENCE DONALD EWERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
HSPP
Contact information
Practice address
806 JACKSON ST, COLUMBUS, IN 47201-6264
(812) 379-4033
(812) 378-8367
Mailing address
720 N MARR RD, COLUMBUS, IN 47201-6660
(812) 314-3500
(812) 378-8367
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
20010172A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000000209012
ANTHEM PIN
IN
Enumeration date
02/01/2006
Last updated
07/08/2007
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