Healthcare Provider Details

I. General information

NPI: 1942495973
Provider Name (Legal Business Name): MANDY M GERSTNER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 09/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 W 21ST ST
CONCORDIA KS
66901-5200
US

IV. Provider business mailing address

PO BOX 747
MANHATTAN KS
66505-0747
US

V. Phone/Fax

Practice location:
  • Phone: 785-243-8900
  • Fax: 785-243-8933
Mailing address:
  • Phone: 785-587-4300
  • Fax: 785-587-4305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number5503
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: