Individual
WANDA GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
425 BROADWAY ST, PADUCAH, KY 42001-0713
(270) 444-3650
Mailing address
425 BROADWAY ST, PADUCAH, KY 42001-0713
(270) 444-3650
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
06/01/2016
Last updated
06/01/2016
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