Provider Demographics
NPI:1255307476
Name:WEGNER, GINGER E (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:GINGER
Middle Name:E
Last Name:WEGNER
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 1:7850 W 245TH AVE
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:IN
Mailing Address - Zip Code:46356-9215
Mailing Address - Country:US
Mailing Address - Phone:219-552-9020
Mailing Address - Fax:219-552-9020
Practice Address - Street 1:1040 E COMMERCIAL AVE
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:IN
Practice Address - Zip Code:46356-2310
Practice Address - Country:US
Practice Address - Phone:219-696-3594
Practice Address - Fax:219-696-3594
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34001984A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S18146Medicare UPIN
IN168050Medicare ID - Type Unspecified