Healthcare Provider Details

I. General information

NPI: 1891489845
Provider Name (Legal Business Name): JOANNE GAMBLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2023
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CROWN POINT CIR
GRASS VALLEY CA
95945-9561
US

IV. Provider business mailing address

453 SACRAMENTO ST
NEVADA CITY CA
95959-3028
US

V. Phone/Fax

Practice location:
  • Phone: 530-265-1437
  • Fax:
Mailing address:
  • Phone: 530-557-0324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW126641
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: