Basic Information
| Provider Information | |||||||||
| NPI: | 1528109345 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RADO-WILFONG | ||||||||
| FirstName: | DOROTHY | ||||||||
| MiddleName: | |||||||||
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| Credential: | LCSW, LMFT, ACSW | ||||||||
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| OtherLastName: | RADO | ||||||||
| OtherFirstName: | DOROTHY | ||||||||
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| OtherCredential: | LCSW, LMFT, ACSW | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 6626 E 75TH ST | ||||||||
| Address2: | STE 500 | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462502805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3176217561 | ||||||||
| FaxNumber: | 3173556096 | ||||||||
| Practice Location | |||||||||
| Address1: | 7 E HENDRICKS ST | ||||||||
| Address2: | |||||||||
| City: | SHELBYVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461762124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3173922564 | ||||||||
| FaxNumber: | 3173929545 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2007 | ||||||||
| LastUpdateDate: | 02/19/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 34002288A | IN | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 106H00000X | 35001252A | IN | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.