Gordon Medlock, PhD, LCSW
Social Worker, Clinical in Michigan City, IN. Individual provider (NPI-1).
NPI number1669917829
StatusActive
Last updated in NPPESDec 27, 2016
Details
- NPI
- 1669917829
- Entity type
- Individual (NPI-1)
- Name
- Gordon Medlock
- Credential
- PhD, LCSW
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Dec 27, 2016
- Last updated
- Dec 27, 2016
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1041C0700X | Social Worker, Clinical | 34003808A | IN | Yes |
Practice location
340 Commerce SqMichigan City, IN 46360-3374
Phone 219-879-3283 · Fax 219-879-6965
Mailing address
340 Commerce SqMichigan City, IN 46360-3374
Phone 219-879-3283 · Fax 219-879-6965
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