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Organization

WILLOWGLEN ACADEMY-IN, INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
CATHERINE ANDERSON LCSW, LCAC (CLINICAL MANAGER)
(219) 886-1320
Entity
Organization

Contact information

Practice address
4955 BROADWAY, GARY, IN 46409-2706
(219) 886-1320
Mailing address
308 E 21ST AVE, GARY, IN 46407-2618
(219) 886-1320

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
34002639A
IN
1041C0700X
Clinical Social Worker
344004861A
IN
163W00000X
Registered Nurse
28072804A
IN
2084P0800X
Psychiatry Physician
Primary
0103158A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200185860
IN
Enumeration date
11/20/2013
Last updated
11/20/2013
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