| Bloomington Center For Connection Benefit Corporation | |
|
315 W Dodds St Bloomington IN 47403-2510 | |
| (812) 669-2227 | |
| Not Available |
| Full Name | Bloomington Center For Connection Benefit Corporation |
|---|---|
| Speciality | Social Worker |
| Location | 315 W Dodds St, Bloomington, Indiana |
| Authorized Official Name and Position | Amy C Makice (DIRECTOR) |
| Authorized Official Contact | 8126692227 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bloomington Center For Connection Benefit Corporation 315 W Dodds St Bloomington IN 47403-2510 Ph: (812) 669-2227 | Bloomington Center For Connection Benefit Corporation 315 W Dodds St Bloomington IN 47403-2510 Ph: (812) 669-2227 |
| NPI Number | 1316612765 |
|---|---|
| Provider Enumeration Date | 08/09/2021 |
| Last Update Date | 08/09/2021 |
| Certification Date | 08/05/2021 |
| Medicare PECOS PAC ID | 0143608117 |
|---|---|
| Medicare Enrollment ID | O20220602002346 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316612765 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Amy C Makice |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093220139 PECOS PAC ID: 1052799020 Enrollment ID: I20220602002506 |
| Provider Name | Jessica Troxel |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558959874 PECOS PAC ID: 1850771429 Enrollment ID: I20220629002624 |
| Provider Name | Katherine Elizabeth Glaser |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174254551 PECOS PAC ID: 0042690323 Enrollment ID: I20220705000240 |
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