Provider Demographics
NPI:1669703922
Name:MCGLOTHIN, TOSHA SHAREE (MSW)
Entity type:Individual
Prefix:
First Name:TOSHA
Middle Name:SHAREE
Last Name:MCGLOTHIN
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 1:7209 ENGLE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-2238
Mailing Address - Country:US
Mailing Address - Phone:260-484-4600
Mailing Address - Fax:260-484-4002
Practice Address - Street 1:7209 ENGLE RD STE 200
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804
Practice Address - Country:US
Practice Address - Phone:260-484-4600
Practice Address - Fax:260-484-4002
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-26
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99088833A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN99088833AOtherTEMP SOCIAL WORKER PERMIT