Basic Information
| Provider Information | |||||||||
| NPI: | 1336431014 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROWE | ||||||||
| FirstName: | LESIA | ||||||||
| MiddleName: | DANELL | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW, PHD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 7300 E INDIANA ST | ||||||||
| Address2: | |||||||||
| City: | EVANSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 477157448 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124018008 | ||||||||
| FaxNumber: | 8124018201 | ||||||||
| Practice Location | |||||||||
| Address1: | 7300 E INDIANA ST | ||||||||
| Address2: | |||||||||
| City: | EVANSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 477157448 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124018008 | ||||||||
| FaxNumber: | 8124018201 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2011 | ||||||||
| LastUpdateDate: | 12/17/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 12/17/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 200242770A | IN | N | Behavioral Health & Social Service Providers | Psychologist | 104100000X | 34003413A | IN | Y | Behavioral Health & Social Service Providers | Social Worker |
ID Information
| ID | Type | State | Issuer | Description | 1134206535 | 01 | IN | GROUP NPI | OTHER |