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NPI Code Detail

MEDICARE: SHAUNA R GAMBLE

MEDICARE: SHAUNA R GAMBLE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorCDCA.169455OH
2171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1003386673
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHAUNA R GAMBLE
Provider Business Mailing Address
First Line : 213 E CHESTNUT ST
Second Line :
City : MOUNT VERNON
State : OH
Zip : 43050
Country : US
Telephone Number : 740-326-9255
Fax Number :
Provider Business Practice Location Address
First Line : 113 W GAMBIER ST
Second Line :
City : MOUNT VERNON
State : OH
Zip : 43050-2421
Country : US
Telephone Number : 740-326-9099
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/27/2018
Last Update Date : 07/05/2023

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Directions to “ SHAUNA R GAMBLE ” Practice Location

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