Provider Demographics
NPI:1811065022
Name:BELUE-WILSON, JANETTE (MSW, ACSW, LCSW,)
Entity type:Individual
Prefix:
First Name:JANETTE
Middle Name:
Last Name:BELUE-WILSON
Suffix:
Gender:F
Credentials:MSW, ACSW, LCSW,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7125 E US HIGHWAY 36
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-7968
Mailing Address - Country:US
Mailing Address - Phone:317-272-2190
Mailing Address - Fax:317-272-2199
Practice Address - Street 1:7125 E US HIGHWAY 36
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-7968
Practice Address - Country:US
Practice Address - Phone:317-272-2190
Practice Address - Fax:317-272-2199
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34001449A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100134140AMedicaid
IN343540Medicare PIN
IN182920Medicare PIN
IN182920BMedicare ID - Type UnspecifiedMEDICARE JAN BELUE-WILSON