Individual
AMANDA PAULETTE GANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
344 FRONT ST STE A, KETCHIKAN, AK 99901-6431
(572) 999-0107
Mailing address
PO BOX 519, WARD COVE, AK 99928-0519
(907) 204-0874
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
215055
AK
104100000X
Social Worker
215055
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1366719759
—
AK
Enumeration date
10/27/2020
Last updated
08/01/2024
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