Provider Demographics
NPI:1376529123
Name:PROESCHOLDT-SHAW, ANN LOUISE (MA, LCSW)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:LOUISE
Last Name:PROESCHOLDT-SHAW
Suffix:
Gender:F
Credentials:MA, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 S 25TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:47362-3526
Mailing Address - Country:US
Mailing Address - Phone:765-593-9165
Mailing Address - Fax:765-593-9165
Practice Address - Street 1:209 S 25TH ST
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:IN
Practice Address - Zip Code:47362-3526
Practice Address - Country:US
Practice Address - Phone:765-593-9165
Practice Address - Fax:765-593-9165
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39000206101YM0800X
IN340022111041C0700X
IN35000219106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000176250OtherANTHEM PIN NUMBER
IN000000176250OtherANTHEM PIN NUMBER