Provider Demographics
NPI:1962688267
Name:DUNGAN, GERALD WAYNE (LICSW)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:WAYNE
Last Name:DUNGAN
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 6TH AVENUE NORTH
Mailing Address - Street 2:ST CLOUD HOSPITAL
Mailing Address - City:ST CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-1901
Mailing Address - Country:US
Mailing Address - Phone:320-251-2700
Mailing Address - Fax:320-255-5806
Practice Address - Street 1:1406 6TH AVENUE NORTH
Practice Address - Street 2:ST CLOUD HOSPITAL CENTRACARE HEALTH PLAZA
Practice Address - City:ST CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-1901
Practice Address - Country:US
Practice Address - Phone:320-251-2700
Practice Address - Fax:320-255-5806
Is Sole Proprietor?:No
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN32861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical