Provider Demographics
NPI:1578886875
Name:GADLAGE, JULIA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JULIA
Middle Name:
Last Name:GADLAGE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:JULIA
Other - Middle Name:
Other - Last Name:FRIEND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:PO BOX 553
Mailing Address - Street 2:
Mailing Address - City:LINTON
Mailing Address - State:IN
Mailing Address - Zip Code:47441-0553
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:620 8TH AVE
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47804-2744
Practice Address - Country:US
Practice Address - Phone:812-231-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-02
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042392A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200982510Medicaid