Provider Demographics
NPI:1730928078
Name:WAKEFIELD, LINDSEY (LSW)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:WAKEFIELD
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-3871
Mailing Address - Country:US
Mailing Address - Phone:765-573-5567
Mailing Address - Fax:
Practice Address - Street 1:323 E 2ND ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-3871
Practice Address - Country:US
Practice Address - Phone:765-573-5567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-24
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
IN33012324A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker