Provider Demographics
NPI:1881974608
Name:PETTIGREW, VERLILIA ANN (LSW, MSW)
Entity type:Individual
Prefix:MS
First Name:VERLILIA
Middle Name:ANN
Last Name:PETTIGREW
Suffix:
Gender:F
Credentials:LSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2144 TANEY PL
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46404-2932
Mailing Address - Country:US
Mailing Address - Phone:219-977-8317
Mailing Address - Fax:
Practice Address - Street 1:2144 TANEY PL
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46404
Practice Address - Country:US
Practice Address - Phone:219-977-8317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-24
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker