MEDICARE: KAMI GAMBLE

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	191515	OH

General Provider Information

NPI Number	:	1477350247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAMI GAMBLE

Provider Business Mailing Address
First Line	:	330 BLACK HOOF ST
Second Line	:
City	:	CIRCLEVILLE
State	:	OH
Zip	:	43113-3207
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4300 W BROAD ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43228-1619
Country	:	US
Telephone Number	:	614-705-2767
Fax Number	:

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

Provider Enumeration Date	:	02/27/2025
Last Update Date	:	02/27/2025

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Directions to “ KAMI GAMBLE ” Practice Location

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