Active NPI
Gordon Medlock, PHD, LCSW
- Clinical Social Worker
- Michigan City, IN
National Provider Identifier
1669917829
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 34003808A
- Practice address
- 340 Commerce SQ
Michigan City, IN 46360-3374 - Phone
- (219) 879-3283
- Fax
- (219) 879-6965
- NPI assigned
- Dec 27, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 34003808A | IN | Primary |
Addresses
Primary practice location
340 Commerce SQ
Michigan City, IN 46360-3374
Mailing address
340 Commerce SQ
Michigan City, IN 46360-3374
Phone (219) 879-3283
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34003808A | IN | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1482796800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1482796800000",
"number": "1669917829",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "340 COMMERCE SQ",
"city": "MICHIGAN CITY",
"state": "IN",
"postal_code": "463603374",
"telephone_number": "219-879-3283",
"fax_number": "219-879-6965"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "340 COMMERCE SQ",
"city": "MICHIGAN CITY",
"state": "IN",
"postal_code": "463603374",
"telephone_number": "219-879-3283",
"fax_number": "219-879-6965"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEDLOCK",
"first_name": "GORDON",
"credential": "PHD, LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-12-27",
"last_updated": "2016-12-27",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IN",
"license": "34003808A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Michigan City, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.