Provider Demographics
NPI:1619391638
Name:GANGLER, KATIE R (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:R
Last Name:GANGLER
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 1:4623 SHENANDOAH DR.
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241
Mailing Address - Country:US
Mailing Address - Phone:502-314-2952
Mailing Address - Fax:502-721-0321
Practice Address - Street 1:808 LYNDON LN STE 204
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222
Practice Address - Country:US
Practice Address - Phone:502-314-2952
Practice Address - Fax:502-721-0321
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-11
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100326520Medicaid