MEDICARE: DR. ROD GARDIN PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1114734118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROD GARDIN PH.D.

Provider Business Mailing Address
First Line	:	444 SOUTHFIELD LN
Second Line	:
City	:	VALPARAISO
State	:	IN
Zip	:	46385-9645
Country	:	US
Telephone Number	:	219-510-4217
Fax Number	:

Provider Business Practice Location Address
First Line	:	2702 GLENDALE BLVD
Second Line	:
City	:	VALPARAISO
State	:	IN
Zip	:	46383-3982
Country	:	US
Telephone Number	:	219-510-4217
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2024
Last Update Date	:	12/12/2024

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