Provider Demographics
NPI:1609093004
Name:BJERKE, GLORIA JEAN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:JEAN
Last Name:BJERKE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:929 FRY RD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-1820
Mailing Address - Country:US
Mailing Address - Phone:317-888-9809
Mailing Address - Fax:317-888-9809
Practice Address - Street 1:384 N MADISON AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-2304
Practice Address - Country:US
Practice Address - Phone:317-888-2271
Practice Address - Fax:317-888-9809
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34001108A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health