=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457655961
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JODI LYNNE GAHAGEN BSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/28/2010
-----------------------------------------------------
Last Update Date | 12/28/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 317 POWER ST
-----------------------------------------------------
City | JOHNSTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15906-2730
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-536-1555
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 902 17TH ST
-----------------------------------------------------
City | WINDBER
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15963-1808
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------