Provider Demographics
NPI:1114734118
Name:GARDIN, ROD (PHD)
Entity type:Individual
Prefix:DR
First Name:ROD
Middle Name:
Last Name:GARDIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 SOUTHFIELD LN
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-9645
Mailing Address - Country:US
Mailing Address - Phone:219-510-4217
Mailing Address - Fax:
Practice Address - Street 1:2702 GLENDALE BLVD
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-3982
Practice Address - Country:US
Practice Address - Phone:219-510-4217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)