Basic Information
| Provider Information | |||||||||
| NPI: | 1902990070 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GIBBONS | ||||||||
| FirstName: | JODI | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 327 SW FRAZIER AVE | ||||||||
| Address2: | |||||||||
| City: | TOPEKA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 666061963 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852956916 | ||||||||
| FaxNumber: | 7852324098 | ||||||||
| Practice Location | |||||||||
| Address1: | 741 SW GRANDVIEW AVE | ||||||||
| Address2: | |||||||||
| City: | TOPEKA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 666061818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852711280 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | LMSW6260 | KS | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.