Provider Demographics
NPI:1700944253
Name:GOSSARD, SAYLA L (LCSW)
Entity Type:Individual
Prefix:
First Name:SAYLA
Middle Name:L
Last Name:GOSSARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1258
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46015-1258
Mailing Address - Country:US
Mailing Address - Phone:765-649-8161
Mailing Address - Fax:765-641-8274
Practice Address - Street 1:2020 BROWN ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016-4218
Practice Address - Country:US
Practice Address - Phone:765-649-8161
Practice Address - Fax:765-641-8274
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
091390EMedicare ID - Type Unspecified