Individual
MRS. KOURTNEY MARIE GALLEGOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
421 S WALNUT ST STE 200, MUNCIE, IN 47305-2484
(765) 288-1790
Mailing address
645 S ROGERS ST, BLOOMINGTON, IN 47403-2353
(812) 339-1691
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
Primary
34008725A
IN
Other
Enumeration date
08/24/2016
Last updated
02/10/2020
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