Provider Demographics
NPI:1972749257
Name:KANNAPEL GILBERT, MISTY LEE (LCSW, MSSW, CSW)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:LEE
Last Name:KANNAPEL GILBERT
Suffix:
Gender:F
Credentials:LCSW, MSSW, CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3116 HERITAGE HEIGHTS WAY
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-8933
Mailing Address - Country:US
Mailing Address - Phone:812-284-0114
Mailing Address - Fax:
Practice Address - Street 1:1060 SHARON DR
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-4522
Practice Address - Country:US
Practice Address - Phone:812-206-1651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-17
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
IN34006029A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker