Provider Demographics
NPI:1508489964
Name:BIAS, SALLY ESTELLE (LSW)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:ESTELLE
Last Name:BIAS
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 1:6330 WONDER LN
Mailing Address - Street 2:
Mailing Address - City:WHITESTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:46075-4004
Mailing Address - Country:US
Mailing Address - Phone:317-796-2153
Mailing Address - Fax:
Practice Address - Street 1:220 S ELM ST
Practice Address - Street 2:
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-1601
Practice Address - Country:US
Practice Address - Phone:317-873-8140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-20
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN3300918A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker