Provider Demographics
NPI:1831710201
Name:WARDLOW, MARGARET R
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:R
Last Name:WARDLOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 LAKE AVENUE
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-6915
Mailing Address - Country:US
Mailing Address - Phone:260-715-8256
Mailing Address - Fax:
Practice Address - Street 1:2121 LAKE AVENUE
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-6915
Practice Address - Country:US
Practice Address - Phone:260-715-8256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-27
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33008584A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker