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General NPI Number Information
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NPI Number | 1649527110
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Entity Type | Individual
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Provider Name | SHANNON L GNACINSKI LSW
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Gender | Female
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Dates
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Enumeration Date | 08/14/2012
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Last Update Date | 08/14/2012
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Provider Practice Location Address
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Address Line | 135 E 38TH ST
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City | ERIE
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State | PA
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Zip | 16504-1559
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Country | US
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Telephone | 814-860-2472
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Fax | 814-868-6247
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Provider Business Mailing Address
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Address Line | 2704 MELROSE AVE
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City | ERIE
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State | PA
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Zip | 16508-1437
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | SW124870
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License Number State | PA
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