Provider Demographics
NPI:1437498193
Name:DETWILER, AARON BLAINE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:BLAINE
Last Name:DETWILER
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 W LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-5907
Mailing Address - Country:US
Mailing Address - Phone:574-534-2161
Mailing Address - Fax:574-534-3887
Practice Address - Street 1:1930 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-5907
Practice Address - Country:US
Practice Address - Phone:574-534-2161
Practice Address - Fax:574-534-3887
Is Sole Proprietor?:No
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34006654A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical