Organization
JAXIE GUNNER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAXIE KAY GUNNER L.C.S.W. (PRESIDENT/CEO)
(724) 980-1504
Entity
Organization
Contact information
Practice address
408 8TH ST, SUITE 5, NEW KENSINGTON, PA 15068-6426
(724) 980-1504
(724) 212-3345
Mailing address
408 8TH ST, SUITE 5, NEW KENSINGTON, PA 15068-6426
(724) 212-3345
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CW016514
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102458480-0001
—
PA
Enumeration date
10/26/2011
Last updated
10/26/2011
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