Basic Information
| Provider Information | |||||||||
| NPI: | 1679710289 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAWLER | ||||||||
| FirstName: | GWEN | ||||||||
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| Credential: | LISW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1401 E 1ST ST | ||||||||
| Address2: | |||||||||
| City: | DULUTH | ||||||||
| State: | MN | ||||||||
| PostalCode: | 558052407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2187284491 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1807 WEST HIGHWAY 61 | ||||||||
| Address2: | |||||||||
| City: | GRAND MARAIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2183879444 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2009 | ||||||||
| LastUpdateDate: | 01/20/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 3925 | MN | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.