Provider Demographics
NPI:1164053088
Name:ASSALONE, LEE-ANN SUSAN (LSW)
Entity Type:Individual
Prefix:
First Name:LEE-ANN
Middle Name:SUSAN
Last Name:ASSALONE
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47713-1252
Mailing Address - Country:US
Mailing Address - Phone:812-421-7489
Mailing Address - Fax:812-436-0209
Practice Address - Street 1:25 W DIVISION ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-1374
Practice Address - Country:US
Practice Address - Phone:812-436-0205
Practice Address - Fax:812-602-2172
Is Sole Proprietor?:No
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33009437A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker