Provider Demographics
NPI:1013940303
Name:LAMPKE, DAVID N (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:N
Last Name:LAMPKE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1332 W ARCH HAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-2079
Mailing Address - Country:US
Mailing Address - Phone:812-349-4406
Mailing Address - Fax:812-349-4418
Practice Address - Street 1:1332 W ARCH HAVEN AVE
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-2079
Practice Address - Country:US
Practice Address - Phone:812-349-4406
Practice Address - Fax:812-349-4418
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34001604A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical