Provider Demographics
NPI:1558529933
Name:GRATZ, CHERYL AMANDA (LSW)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:AMANDA
Last Name:GRATZ
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2414 E STATE BLVD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-4760
Mailing Address - Country:US
Mailing Address - Phone:260-373-8060
Mailing Address - Fax:260-373-8042
Practice Address - Street 1:2414 E STATE BLVD
Practice Address - Street 2:SUITE 304
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-4760
Practice Address - Country:US
Practice Address - Phone:260-373-8060
Practice Address - Fax:260-373-8042
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33000009A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker