Provider Information for 1174731509
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Ms. JANE B GOTSHALK LICSW
Sex: Female
NPI: 1174731509
Last Updated: 2024-05-17
Certification Date: 2024-05-17
Certification Date: 2024-05-17
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1174731509 | ||||||||
| Enumeration Date | 2007-05-18 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 109 COURAGE LOOP FORT STEWART, GA 31315-5906 United States Phone: 706-315-9407 | Fax: | ||||||||
| Primary Practice Address | 109 COURAGE LOOP FORT STEWART, GA 31315-5906 United States Phone: 706-315-9407 | Fax: | ||||||||
| Secondary Practice Address(es) | 929 MASSACHUSETTS AVE STE M03 | ||||||||
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