Healthcare Provider Details

I. General information

NPI: 1265529804
Provider Name (Legal Business Name): GRETCHEN ANN CHILDRESS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 E ELNORA ST
ODON IN
47562-1150
US

IV. Provider business mailing address

16174 N 1100 E
ODON IN
47562-5553
US

V. Phone/Fax

Practice location:
  • Phone: 812-363-1300
  • Fax:
Mailing address:
  • Phone: 812-489-1176
  • Fax: 812-996-0439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34005738A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: