Provider Demographics
NPI:1023290137
Name:NIELSEN, AIMEE M (LCSW)
Entity type:Individual
Prefix:
First Name:AIMEE
Middle Name:M
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:AIMEE
Other - Middle Name:M
Other - Last Name:EDMONDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10765 LANTERN ROAD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-3597
Mailing Address - Country:US
Mailing Address - Phone:317-621-4181
Mailing Address - Fax:317-621-4182
Practice Address - Street 1:10765 LANTERN ROAD
Practice Address - Street 2:SUITE 102
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-3597
Practice Address - Country:US
Practice Address - Phone:317-621-4181
Practice Address - Fax:317-621-4182
Is Sole Proprietor?:No
Enumeration Date:2007-11-30
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005917A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN3423806OtherCIGNA
IN682352OtherVALUE OPTIONS
IN482619OtherMANAGED HEALTH NETWORK
IN000000701149OtherANTHEM
IN9084133OtherAETNA
INM400039893Medicare PIN