Provider Demographics
NPI:1902952146
Name:GENTRY, SONDRA KATENA (MA)
Entity Type:Individual
Prefix:MS
First Name:SONDRA
Middle Name:KATENA
Last Name:GENTRY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8948 SCOTER CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46234-8521
Mailing Address - Country:US
Mailing Address - Phone:317-924-5205
Mailing Address - Fax:317-931-2393
Practice Address - Street 1:1050 W 42ND ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46208-3301
Practice Address - Country:US
Practice Address - Phone:317-924-5205
Practice Address - Fax:317-931-2393
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X
OHS0700001104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker