Healthcare Provider Details

I. General information

NPI: 1487955720
Provider Name (Legal Business Name): TAMALA GDOWSKI LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2010
Last Update Date: 11/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 HOSPITAL DR
ATHENS OH
45701-2301
US

IV. Provider business mailing address

90 HOSPITAL DR
ATHENS OH
45701-2301
US

V. Phone/Fax

Practice location:
  • Phone: 740-593-3682
  • Fax: 740-594-5642
Mailing address:
  • Phone: 740-593-3682
  • Fax: 740-594-5642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1.1000261
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: