Provider Demographics
NPI:1518182781
Name:DRIBBLE, MADELON JOAN (LCSW)
Entity type:Individual
Prefix:
First Name:MADELON
Middle Name:JOAN
Last Name:DRIBBLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7917 WINSTON LN
Mailing Address - Street 2:4630 WEST JEFFERSON BLVD.
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-5780
Mailing Address - Country:US
Mailing Address - Phone:260-399-4357
Mailing Address - Fax:
Practice Address - Street 1:7917 WINSTON LN
Practice Address - Street 2:4630 WEST JEFFERSON BLVD.
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-5780
Practice Address - Country:US
Practice Address - Phone:260-442-8892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005312A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical