Provider Demographics
NPI:1619200193
Name:HADLOCK, GILLIAN (MSW)
Entity Type:Individual
Prefix:MS
First Name:GILLIAN
Middle Name:
Last Name:HADLOCK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3259 W 48TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46228-2103
Mailing Address - Country:US
Mailing Address - Phone:617-680-3277
Mailing Address - Fax:
Practice Address - Street 1:1005 S MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:IN
Practice Address - Zip Code:46052-2784
Practice Address - Country:US
Practice Address - Phone:765-482-7421
Practice Address - Fax:765-482-7462
Is Sole Proprietor?:No
Enumeration Date:2009-09-15
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
IN34006476A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker