Provider Demographics
NPI:1134249527
Name:LOHSE, CAROLYN (LCSW)
Entity type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:
Last Name:LOHSE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:CAROLYN
Other - Middle Name:
Other - Last Name:KRUGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 1921
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385
Mailing Address - Country:US
Mailing Address - Phone:219-395-6637
Mailing Address - Fax:219-465-0784
Practice Address - Street 1:684 VALLEY DRIVE
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383
Practice Address - Country:US
Practice Address - Phone:219-395-6637
Practice Address - Fax:219-465-0784
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34001814A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN228660Medicare PIN