Individual
MICHAEL GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4950 W 23RD ST STE 1, ERIE, PA 16506-5803
(814) 459-2755
(814) 456-4873
Mailing address
4950 W 23RD ST STE 1, ERIE, PA 16506-5803
(814) 459-2755
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
SW136735
PA
Other
Enumeration date
12/22/2021
Last updated
12/22/2021
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