Individual
JETAUN T GARDNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LSW
Contact information
Practice address
9335 CALUMET AVE STE D, MUNSTER, IN 46321-4176
(219) 836-9200
(219) 836-4200
Mailing address
9335 CALUMET AVE STE D, MUNSTER, IN 46321-4176
(219) 836-9200
(219) 836-4200
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
99087806A
IN
Other
Enumeration date
08/07/2018
Last updated
08/07/2018
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