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NPI Code Detail

MEDICARE: JACK F GAMBLE LCSW

MEDICARE: JACK F GAMBLE LCSW
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
11041C0700XClinical Social Worker12008FL
21041C0700XClinical Social WorkerC012820NC

General Provider Information

NPI Number : 1578686663
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACK F GAMBLE LCSW
Provider Business Mailing Address
First Line : 8072 NORMANDY DR
Second Line :
City : FORT RILEY
State : KS
Zip : 66442-7069
Country : US
Telephone Number : 785-240-5543
Fax Number :
Provider Business Practice Location Address
First Line : 8072 NORMANDY DR
Second Line :
City : FORT RILEY
State : KS
Zip : 66442-7069
Country : US
Telephone Number : 785-240-5543
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2007
Last Update Date : 10/25/2021

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Directions to “ JACK F GAMBLE LCSW” Practice Location

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