Healthcare Provider Details

I. General information

NPI: 1346987823
Provider Name (Legal Business Name): GWENDOLYNNE NOONAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2022
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

697 LOUISIANA RD
DYESS AFB TX
79607-1141
US

IV. Provider business mailing address

697 LOUISIANA RD
DYESS AFB TX
79607-1141
US

V. Phone/Fax

Practice location:
  • Phone: 325-696-4262
  • Fax: 325-696-4262
Mailing address:
  • Phone: 303-550-9491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC017925
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number115475
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: