Individual
ANGELA BEANBLOSSOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
289 IRELAND AVE, MEDDAC BLDG 851 RM 9-40, FORT KNOX, KY 40121-5111
(502) 624-9006
Mailing address
4329 W MOUNT CARMEL RD, SALEM, IN 47167-8258
(812) 472-3710
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34004306A
IN
Other
Enumeration date
02/21/2011
Last updated
02/21/2011
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