Provider Demographics
NPI:1053630053
Name:GAMMON, LUANN ANNETTE (LGSW)
Entity Type:Individual
Prefix:
First Name:LUANN
Middle Name:ANNETTE
Last Name:GAMMON
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11414 GREAT RIVER RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56345-4537
Mailing Address - Country:US
Mailing Address - Phone:320-632-2400
Mailing Address - Fax:
Practice Address - Street 1:11414 GREAT RIVER RD
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:MN
Practice Address - Zip Code:56345-4537
Practice Address - Country:US
Practice Address - Phone:320-632-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-31
Last Update Date:2010-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN94931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical