Provider Demographics
NPI:1720491079
Name:RANDALL, NATALIE ANNE (MSW)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:ANNE
Last Name:RANDALL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 HAWICK DR
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-9331
Mailing Address - Country:US
Mailing Address - Phone:952-237-1159
Mailing Address - Fax:
Practice Address - Street 1:87 HAWICK DR
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46385-9331
Practice Address - Country:US
Practice Address - Phone:952-237-1159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-04
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34011799A1041C0700X
IL149.0287821041C0700X
MN173011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical