Provider Demographics
NPI:1972850253
Name:GALLOWAY, JODIE FERN (LMSW)
Entity Type:Individual
Prefix:
First Name:JODIE
Middle Name:FERN
Last Name:GALLOWAY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1913 BROMILOW ST
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-5152
Mailing Address - Country:US
Mailing Address - Phone:575-202-1954
Mailing Address - Fax:
Practice Address - Street 1:1913 BROMILOW ST
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-5152
Practice Address - Country:US
Practice Address - Phone:575-202-1954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-059161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical