Healthcare Provider Details

I. General information

NPI: 1508297060
Provider Name (Legal Business Name): SONJA GAMBLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2013
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 LANDSDOWNE DR
ASHLAND KY
41102-5422
US

IV. Provider business mailing address

PO BOX 790
ASHLAND KY
41105-0790
US

V. Phone/Fax

Practice location:
  • Phone: 866-233-1955
  • Fax: 606-475-3219
Mailing address:
  • Phone: 606-329-8588
  • Fax: 606-329-8195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number1582
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: