Unknown Individual – Clinical Social Worker, NPI 1366528655

Clinical Social Worker

Unknown Individual is a healthcare provider. based in Muncie, Indiana. specializing in Clinical Social Worker. They hold a License No. 34002038A (IN). The NPI Number for Unknown Individual is 1366528655

Main info

Organization

Inactive

38 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1366528655

Phone

(765) 751-3378

Address

3813 S MADISON ST

Deactivation Date

20 April 2022

Doctor Profile

Medical School Name

OTHER

Secondary Phone

7652895520

Graduation Year

1988 (38 years ago)

PAC ID

8022197714

Group Practice PAC ID

6608196787

Professional Enrollment ID

I20080506000782

Data current as of

19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience14

Completeness75

Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

3813, South Madison Street, Muncie, Delaware County, Indiana, 47302, United States
MUNCIE, IN 473025758
Phone: (765) 751-3378
Type: Location
2105, South Hackley Street, Muncie, Delaware County, Indiana, 47302, United States
MUNCIE, IN 473024242
Phone: (765) 282-6909
Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 47302)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.

PAC ID: 6608196787View full group profile

Name	Specialty	State
STEFANIA AEGISDOTTIR (PHD)	Clinical Psychologist	IN
MS. MALYSSA MAY (LMHC)	Mental Health Counselor	IN
DR. GISSELLE OLIVIA MCKELL-JEFFERS (PH.D.)	Clinical Psychologist	IN
BRIAN HART (LMHC)	Mental Health Counselor	IN
JESSICA SLAVEN (LSW)	Clinical Social Worker	IN
BARBARA SIEGEL MCCONNELL (LCSW)	Clinical Social Worker	IN
VICTORIA SUE (LMHC-A)	Mental Health Counselor	IN
HEATHER R STEVENSON (L.C.S.W.)	Clinical Social Worker	IN
WILLARD J. FREDERICK (LCSW)	Clinical Social Worker	IN
MS. CATHERINE C BALLARD (LMHC)	Mental Health Counselor	IN

Reviews

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Frequently asked questions

What is the standard ID for Unknown Individual in the U.S.?

In the U.S., Unknown Individual is identified by NPI 1366528655.

What should I verify if Unknown Individual is listed inactive?

If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.

What services align with Unknown Individual's listing?

Unknown Individual's public classification highlights Clinical Social Worker. Clinical services aligned with this taxonomy classification.

Which community is linked to Unknown Individual?

Unknown Individual shows a connection to Muncie, Indiana in registry-derived data.

Can I export Unknown Individual's record?

You can download the official NPPES record; we summarize key fields for readability.