Individual
CAROLYN GEDULD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1120 E 1ST ST, BLOOMINGTON, IN 47401-5006
(812) 369-8389
Mailing address
1120 E 1ST ST, BLOOMINGTON, IN 47401-5006
(812) 369-8389
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34000542A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000298179
ANTHEM
IN
Enumeration date
02/09/2006
Last updated
06/28/2011
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