Provider Demographics
NPI:1164638326
Name:EILER, GWENDA SUE (MSW)
Entity type:Individual
Prefix:MS
First Name:GWENDA
Middle Name:SUE
Last Name:EILER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 STADIUM MALL DR.
Mailing Address - Street 2:PURDUE UNIVERISTY STUDENT HEALTH CENTER
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47907-2052
Mailing Address - Country:US
Mailing Address - Phone:765-494-6995
Mailing Address - Fax:765-496-2139
Practice Address - Street 1:1601 STADIUM MALL DR.
Practice Address - Street 2:PURDUE UNIVERISTY STUDENT HEALTH CENTER
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47907-2052
Practice Address - Country:US
Practice Address - Phone:765-494-6995
Practice Address - Fax:765-496-2139
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34000563A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical