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2437 Shelby St Indianapolis IN 46203-4252 | |
| (317) 557-5091 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Social Worker |
| Location | 2437 Shelby St, Indianapolis, Indiana |
| Authorized Official Name and Position | Rebecca Waletich (THERAPIST/OWNER) |
| Authorized Official Contact | 3177797574 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 47 Jackson MI 49204-0047 Ph: (317) 557-5091 | 2437 Shelby St Indianapolis IN 46203-4252 Ph: (317) 557-5091 |
| NPI Number | 1063884617 |
|---|---|
| Provider Enumeration Date | 10/22/2015 |
| Last Update Date | 11/22/2024 |
| Certification Date | 11/22/2024 |
| Medicare PECOS PAC ID | 2062716947 |
|---|---|
| Medicare Enrollment ID | O20160215000072 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063884617 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 34004596A (Indiana) | Primary |
| Provider Name | Rebecca J Waletich |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1437459583 PECOS PAC ID: 3870897762 Enrollment ID: I20160215000153 |
| Provider Name | Meredith I Coy |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1003471525 PECOS PAC ID: 6901131416 Enrollment ID: I20190703002696 |
| Provider Name | Kelsey Hug |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215589494 PECOS PAC ID: 2062740723 Enrollment ID: I20190820002095 |
| Provider Name | Madallyn Warner Bagley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1376191270 PECOS PAC ID: 1557692092 Enrollment ID: I20191014002788 |
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