Provider Demographics
NPI:1487690491
Name:EPP, ARLEN W (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:ARLEN
Middle Name:W
Last Name:EPP
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 384
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-0384
Mailing Address - Country:US
Mailing Address - Phone:231-775-6076
Mailing Address - Fax:231-775-0027
Practice Address - Street 1:3040A WINDSOR CT
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-5555
Practice Address - Country:US
Practice Address - Phone:574-262-9305
Practice Address - Fax:574-262-9516
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34003644A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S84033Medicare UPIN
233810AMedicare ID - Type Unspecified