Healthcare Provider Details

I. General information

NPI: 1184028326
Provider Name (Legal Business Name): CHRISTINA GAWEDZINSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2014
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 W COLLEGE ST
TROY MO
63379-1101
US

IV. Provider business mailing address

219 W COLLEGE ST
TROY MO
63379-1101
US

V. Phone/Fax

Practice location:
  • Phone: 636-528-1488
  • Fax:
Mailing address:
  • Phone: 636-528-1488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2012040937
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: