Healthcare Provider Details

I. General information

NPI: 1144646571
Provider Name (Legal Business Name): GWEN SPERLING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2014
Last Update Date: 03/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 SAINT MICHAELS DR SUITE 250
SANTA FE NM
87505-7602
US

IV. Provider business mailing address

440 SAINT MICHAELS DR SUITE 250
SANTA FE NM
87505-7602
US

V. Phone/Fax

Practice location:
  • Phone: 505-913-3056
  • Fax: 505-989-6021
Mailing address:
  • Phone: 505-913-3056
  • Fax: 505-989-6021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-07983
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: