Provider Demographics
NPI:1912005364
Name:WARDELL, GALE
Entity Type:Individual
Prefix:MISS
First Name:GALE
Middle Name:
Last Name:WARDELL
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:GALE
Other - Middle Name:W
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSSW,LCSW,BCD
Mailing Address - Street 1:1338 PAPERMILL POINTE WAY
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909
Mailing Address - Country:US
Mailing Address - Phone:865-558-3011
Mailing Address - Fax:865-588-3851
Practice Address - Street 1:1338 PAPERMILL POINTE WAY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909
Practice Address - Country:US
Practice Address - Phone:865-558-3011
Practice Address - Fax:865-588-3851
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN386 LCSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical