Provider Demographics
NPI:1063814762
Name:IKERD, AMY (MSW LCSW LCAC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:IKERD
Suffix:
Gender:F
Credentials:MSW LCSW LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5660 CAITO DRIVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46203
Mailing Address - Country:US
Mailing Address - Phone:317-755-8050
Mailing Address - Fax:
Practice Address - Street 1:5660 CAITO DR
Practice Address - Street 2:SUITE 120
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46226-1372
Practice Address - Country:US
Practice Address - Phone:317-755-8050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN87000030A101YA0400X
IN34006819A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)