| Lisa S Gonzenbach Llc | |
|
3600 Watermelon Rd Suite 202 Northport AL 35473-5169 | |
| (205) 750-0181 | |
| Not Available |
| Full Name | Lisa S Gonzenbach Llc |
|---|---|
| Speciality | Social Worker |
| Location | 3600 Watermelon Rd, Northport, Alabama |
| Authorized Official Name and Position | Lisa Gonzenbach (OWNER) |
| Authorized Official Contact | 2057500181 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lisa S Gonzenbach Llc 3600 Watermelon Rd Suite 202 Northport AL 35473-5169 Ph: (205) 750-0181 | Lisa S Gonzenbach Llc 3600 Watermelon Rd Suite 202 Northport AL 35473-5169 Ph: (205) 750-0181 |
| NPI Number | 1861828519 |
|---|---|
| Provider Enumeration Date | 09/25/2013 |
| Last Update Date | 01/23/2014 |
| Medicare PECOS PAC ID | 0042441263 |
|---|---|
| Medicare Enrollment ID | O20140401000143 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861828519 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 0969C (Alabama) | Primary |
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