Provider Demographics
NPI:1558598599
Name:THOMAS, GWENDOLYN (LCSW)
Entity Type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 STATE STREET
Mailing Address - Street 2:SUITE #2
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031
Mailing Address - Country:US
Mailing Address - Phone:412-416-2765
Mailing Address - Fax:360-844-5184
Practice Address - Street 1:208 STATE STREET
Practice Address - Street 2:SUITE #2
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-2036
Practice Address - Country:US
Practice Address - Phone:541-241-6276
Practice Address - Fax:360-844-5184
Is Sole Proprietor?:No
Enumeration Date:2009-06-17
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL44281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR147878OtherMEDICARE PTAN
OR139670Medicaid
OR500801640Medicaid