| Nancy Logan Detweiler Lcsw | |
|
4830 Nw 43rd St Gainesville FL 32606-4401 | |
| (352) 338-1321 | |
| (352) 376-3872 |
| Full Name | Nancy Logan Detweiler Lcsw |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 4830 Nw 43rd St, Gainesville, Florida |
| Authorized Official Name and Position | Nancy Logan Detweiler (OWNER) |
| Authorized Official Contact | 3523381321 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Nancy Logan Detweiler Lcsw 4830 Nw 43rd St C45 Gainesville FL 32606-4600 Ph: (352) 338-1321 | Nancy Logan Detweiler Lcsw 4830 Nw 43rd St Gainesville FL 32606-4401 Ph: (352) 338-1321 |
| NPI Number | 1588177711 |
|---|---|
| Provider Enumeration Date | 11/09/2017 |
| Last Update Date | 11/09/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588177711 | NPI | - | NPPES |
| 1780727149 | Medicaid | FL | |
| 11403345 | Other | PISO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | SW859 (Florida) | Primary |
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