Healthcare Provider Details

I. General information

NPI: 1518178060
Provider Name (Legal Business Name): LINDA M GUNVILLE LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BIA #152
BELCOURT ND
58316
US

IV. Provider business mailing address

PO BOX 1970
BELCOURT ND
58316-1970
US

V. Phone/Fax

Practice location:
  • Phone: 701-477-0525
  • Fax:
Mailing address:
  • Phone: 701-477-0525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number3627
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: