Provider Demographics
NPI:1356529895
Name:LINDA SUE GENGELBACH
Entity type:Organization
Organization Name:LINDA SUE GENGELBACH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:GENGELBACH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:812-548-0930
Mailing Address - Street 1:746 9TH ST
Mailing Address - Street 2:
Mailing Address - City:TELL CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47586-1711
Mailing Address - Country:US
Mailing Address - Phone:812-548-0930
Mailing Address - Fax:812-548-0931
Practice Address - Street 1:746 9TH ST
Practice Address - Street 2:
Practice Address - City:TELL CITY
Practice Address - State:IN
Practice Address - Zip Code:47586-1711
Practice Address - Country:US
Practice Address - Phone:812-548-0930
Practice Address - Fax:812-548-0931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34003528A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000337944OtherBC/BS
IN000000337944OtherBC/BS