Individual
GORDON MEDLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD, LCSW
Contact information
Practice address
340 COMMERCE SQ, MICHIGAN CITY, IN 46360-3374
(219) 879-3283
(219) 879-6965
Mailing address
340 COMMERCE SQ, MICHIGAN CITY, IN 46360-3374
(219) 879-3283
(219) 879-6965
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34003808A
IN
Other
Enumeration date
12/27/2016
Last updated
12/27/2016
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