Provider Demographics
NPI:1194586511
Name:ELWELL, LAURIE ELAINE (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:ELAINE
Last Name:ELWELL
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:ELAINE
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:7063 BEN DAVIS DR
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-9138
Mailing Address - Country:US
Mailing Address - Phone:219-380-4578
Mailing Address - Fax:
Practice Address - Street 1:7063 BEN DAVIS DR
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-9138
Practice Address - Country:US
Practice Address - Phone:219-380-4578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-22
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005263A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical