Organization
SANDY MAE GANNON COMPANY PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SANDRA MAE GANNON LISW, ACSW (PRESIDENT)
(319) 621-5416
Entity
Organization
Contact information
Practice address
103 S MAIN ST, NORTH ENGLISH, IA 52316-9504
(319) 664-3333
Mailing address
3217 RAVEN ST, IOWA CITY, IA 52245-5129
(319) 621-5416
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
00590
IA
Other
Enumeration date
08/22/2016
Last updated
11/01/2016
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