Provider Demographics
NPI:1588855696
Name:GANNON, CECILLE M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CECILLE
Middle Name:M
Last Name:GANNON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:CECILLE
Other - Middle Name:M
Other - Last Name:GANNON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:874 GRAVENSTEIN AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-4555
Mailing Address - Country:US
Mailing Address - Phone:707-326-6609
Mailing Address - Fax:
Practice Address - Street 1:874 GRAVENSTEIN AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-4555
Practice Address - Country:US
Practice Address - Phone:707-326-6609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program