Individual
MARLA JEAN WILLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
60448 SURREY LN, ELKHART, IN 46517-9117
(574) 875-1217
Mailing address
60448 SURREY LN, ELKHART, IN 46517-9117
(574) 875-1217
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34005109A
IN
1041C0700X
Clinical Social Worker
S19336
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
118261
AMERICAID GROUP
TX
05
—
167121601
—
TX
01
—
237580JJJJ
MEDICARE
IN
01
—
P00649543
MEDICARE RR#
IN
Enumeration date
01/09/2006
Last updated
04/09/2012
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