Provider Demographics
NPI:1841316353
Name:CHEDIAK, GLORIA J (LSCSW, BCD, DCSW)
Entity type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:J
Last Name:CHEDIAK
Suffix:
Gender:F
Credentials:LSCSW, BCD, DCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 MISSOURI ST
Mailing Address - Street 2:STE 1
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-2353
Mailing Address - Country:US
Mailing Address - Phone:785-841-7430
Mailing Address - Fax:785-841-6411
Practice Address - Street 1:601 MISSOURI ST
Practice Address - Street 2:STE 1
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-2353
Practice Address - Country:US
Practice Address - Phone:785-841-7430
Practice Address - Fax:785-841-6411
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS156101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS011116OtherBLUE CROSS BLUE SHIELD