Provider Demographics
NPI:1124883368
Name:TUCKER, KATHERINE (MSW, LSW)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LSW
Mailing Address - Street 1:10080 E US HIGHWAY 36
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-8173
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10080 E US HIGHWAY 36
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-8173
Practice Address - Country:US
Practice Address - Phone:317-790-9396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-16
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33011521A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker