MEDICARE: MS. JANE B GOTSHALK LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LICSW113296	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174731509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JANE B GOTSHALK LICSW

Provider Business Mailing Address
First Line	:	109 COURAGE LOOP
Second Line	:
City	:	FORT STEWART
State	:	GA
Zip	:	31315-5906
Country	:	US
Telephone Number	:	706-315-9407
Fax Number	:

Provider Business Practice Location Address
First Line	:	109 COURAGE LOOP
Second Line	:
City	:	FORT STEWART
State	:	GA
Zip	:	31315-5906
Country	:	US
Telephone Number	:	706-315-9407
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2007
Last Update Date	:	05/17/2024

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