Provider Demographics
NPI:1033119060
Name:WOLFORD, JOAN PALMQUIST (LCSW)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:PALMQUIST
Last Name:WOLFORD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8400 LOUISIANA STREET
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410
Mailing Address - Country:US
Mailing Address - Phone:251-975-7192
Mailing Address - Fax:219-757-1950
Practice Address - Street 1:290 A EAST 90TH DRIVE
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410
Practice Address - Country:US
Practice Address - Phone:219-736-9115
Practice Address - Fax:219-736-9131
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34001253A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000358154OtherNONE
IN409190DMedicare ID - Type Unspecified