Provider Demographics
NPI:1295847804
Name:GIAUQUE, ANN M (CLINICAL SOCIAL WORK)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:M
Last Name:GIAUQUE
Suffix:
Gender:F
Credentials:CLINICAL SOCIAL WORK
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 N MERIDIAN ST STE 114
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46204-1208
Mailing Address - Country:US
Mailing Address - Phone:317-274-4402
Mailing Address - Fax:317-274-5168
Practice Address - Street 1:702 BARNHILL DR RM 4300
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5128
Practice Address - Country:US
Practice Address - Phone:317-274-8162
Practice Address - Fax:317-274-5168
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34003793A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical