Healthcare Provider Details

I. General information

NPI: 1508984741
Provider Name (Legal Business Name): DEBORAH JEAN GASEK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1756 BEE CREEK RD
BRANSON MO
65616-9395
US

IV. Provider business mailing address

3351 W SEXTON ST
SPRINGFIELD MO
65810-1080
US

V. Phone/Fax

Practice location:
  • Phone: 417-335-2004
  • Fax: 417-335-2012
Mailing address:
  • Phone: 417-799-0433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2005025565
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: