Healthcare Provider Details

I. General information

NPI: 1700977279
Provider Name (Legal Business Name): GAIL JARNAGIN SANGSTER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JEFFERSON ST
VALPARAISO IN
46383-4759
US

IV. Provider business mailing address

696 COVENTRY LN
VALPARAISO IN
46385-8409
US

V. Phone/Fax

Practice location:
  • Phone: 219-465-5515
  • Fax:
Mailing address:
  • Phone: 219-759-3529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34003781A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: