Provider Demographics
NPI:1265529804
Name:CHILDRESS, GRETCHEN ANN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:GRETCHEN
Middle Name:ANN
Last Name:CHILDRESS
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 1:16174 N 1100 E
Mailing Address - Street 2:
Mailing Address - City:ODON
Mailing Address - State:IN
Mailing Address - Zip Code:47562-5553
Mailing Address - Country:US
Mailing Address - Phone:812-489-1176
Mailing Address - Fax:812-996-0439
Practice Address - Street 1:104 N WEST ST
Practice Address - Street 2:
Practice Address - City:ODON
Practice Address - State:IN
Practice Address - Zip Code:47562-1234
Practice Address - Country:US
Practice Address - Phone:812-363-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005738A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical