Provider Demographics
NPI:1629064662
Name:GUNNISON, JANE CAROLYN (MSW)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:CAROLYN
Last Name:GUNNISON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:JANE
Other - Middle Name:CAROLYN
Other - Last Name:KREMPA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:4881 SUGAR MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:WPAFB
Mailing Address - State:OH
Mailing Address - Zip Code:45433-5546
Mailing Address - Country:US
Mailing Address - Phone:937-257-6429
Mailing Address - Fax:937-656-1402
Practice Address - Street 1:4881 SUGAR MAPLE DR
Practice Address - Street 2:5TH FLOOR
Practice Address - City:WPAFB
Practice Address - State:OH
Practice Address - Zip Code:45433-5546
Practice Address - Country:US
Practice Address - Phone:937-257-6429
Practice Address - Fax:937-656-1402
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLISW 1915104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker