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Individual

GWENDOLYN UPSHAW

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
4123 GRACE ST, EAST CHICAGO, IN 46312-2924
(937) 974-6277
Mailing address
4123 GRACE ST, EAST CHICAGO, IN 46312-2924
(937) 974-6277

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
164W00000X
Licensed Practical Nurse
Primary
145673
OH

Other

Enumeration date
09/23/2019
Last updated
04/03/2026
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