Provider Demographics
NPI:1225343833
Name:DUDREY, JENNIFER L (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:L
Last Name:DUDREY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:GILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:954 EASTPORT CENTRE DR STE B
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-4456
Mailing Address - Country:US
Mailing Address - Phone:219-286-6482
Mailing Address - Fax:219-286-7367
Practice Address - Street 1:954 EASTPORT CENTRE DR STE B
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-4456
Practice Address - Country:US
Practice Address - Phone:219-286-6482
Practice Address - Fax:219-286-7367
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34006080A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000714946OtherANTHEM