Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1041C0700X | Clinical Social Worker | 70204683501 | UT |
Y | 1041C0700X | Clinical Social Worker | 70204683502 | UT |
NPI | 1003066945 |
---|---|
Provider Name | Mrs. Chelsea Gambles |
First Address | Cedar City, UT 84721-7149 |
Second Address | Midvale, UT 84047-7148 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2008 |
Last Update Date | 20/06/2011 |