Provider Demographics
NPI:1740934520
Name:LAWSON GONZALEZ, YESSICA NAYELI
Entity type:Individual
Prefix:
First Name:YESSICA
Middle Name:NAYELI
Last Name:LAWSON GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:YESSICA
Other - Middle Name:NAYELI
Other - Last Name:GONZALEZ TORRES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:50832 ACORN TRL
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-7730
Mailing Address - Country:US
Mailing Address - Phone:574-222-6514
Mailing Address - Fax:
Practice Address - Street 1:240 WATERFALL DR
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46516-3668
Practice Address - Country:US
Practice Address - Phone:574-222-6514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33010019A104100000X
IN33010019104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker