MEDICARE: TJITSKE GAY TUBBERGEN-MAGLIO LCSW

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	2009035747	MO

General Provider Information

NPI Number	:	1235468786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TJITSKE GAY TUBBERGEN-MAGLIO LCSW

Provider Business Mailing Address
First Line	:	117 E WASHINGTON ST
Second Line	:	PO BOX 360
City	:	KIRKSVILLE
State	:	MO
Zip	:	63501-2951
Country	:	US
Telephone Number	:	660-665-7805
Fax Number	:	660-665-7805

Provider Business Practice Location Address
First Line	:	117 E WASHINGTON ST
Second Line	:
City	:	KIRKSVILLE
State	:	MO
Zip	:	63501-2951
Country	:	US
Telephone Number	:	660-665-7805
Fax Number	:	660-665-7805

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

Provider Enumeration Date	:	12/11/2009
Last Update Date	:	01/26/2026

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