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NPI Code Detail

MEDICARE: MS. MINNETTE KATHLEEN GAMBLE MPA, SPADA, LLMSW

MEDICARE: MS. MINNETTE KATHLEEN GAMBLE MPA, SPADA, LLMSW
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
11041C0700XClinical Social Worker6801081074MI

Other Identifiers

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

General Provider Information

NPI Number : 1528209095
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MINNETTE KATHLEEN GAMBLE MPA, SPADA, LLMSW
Provider Business Mailing Address
First Line : 168 MAPLE ST
Second Line :
City : SPARTA
State : MI
Zip : 49345-1310
Country : US
Telephone Number : 616-322-6655
Fax Number :
Provider Business Practice Location Address
First Line : 168 MAPLE ST
Second Line :
City : SPARTA
State : MI
Zip : 49345-1310
Country : US
Telephone Number : 616-685-0985
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/13/2009
Last Update Date : 03/08/2011

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