=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558598599
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GWENDOLYN THOMAS LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/17/2009
-----------------------------------------------------
Last Update Date | 05/26/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 208 STATE STREET SUITE #2
-----------------------------------------------------
City | HOOD RIVER
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97031-2036
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-241-6276
-----------------------------------------------------
Fax | 360-844-5184
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 208 STATE STREET SUITE #2
-----------------------------------------------------
City | HOOD RIVER
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-416-2765
-----------------------------------------------------
Fax | 360-844-5184
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | L4428
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------