Provider Demographics
NPI:1285026708
Name:ISAACS, KAREN KAY (CHW/CRS)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:KAY
Last Name:ISAACS
Suffix:
Gender:F
Credentials:CHW/CRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 CONWELL STREET
Mailing Address - Street 2:208 WST 21ST STREET
Mailing Address - City:CONNERSVILLE
Mailing Address - State:INDIANA
Mailing Address - Zip Code:47331
Mailing Address - Country:UM
Mailing Address - Phone:765-338-9885
Mailing Address - Fax:765-222-1249
Practice Address - Street 1:208 W 21ST ST
Practice Address - Street 2:
Practice Address - City:CONNERSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47331-2930
Practice Address - Country:US
Practice Address - Phone:765-338-9885
Practice Address - Fax:765-222-1249
Is Sole Proprietor?:No
Enumeration Date:2015-02-19
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN111Medicaid