Provider Information for 1992281752
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JANA GUMLEY LCSW
Sex: Female
NPI: 1992281752
Last Updated: 2021-03-19
Certification Date: 2021-03-19
Certification Date: 2021-03-19
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1992281752 | ||||||||||||
| Enumeration Date | 2018-07-16 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 22 PLEASANT LN FAIRVIEW HEIGHTS, IL 62208-1814 United States Phone: 865-924-7927 | Fax: | ||||||||||||
| Primary Practice Address | 22 PLEASANT LN FAIRVIEW HEIGHTS, IL 62208-1814 United States Phone: 865-924-7927 | Fax: | ||||||||||||
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