| NPI | 1164456026 |
|---|---|
| Other Name | NICOLE M GANNON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA SW124543) |
| Additional Taxonomies | 104100000X Social Worker (Licence: PA SW124543) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2017-03-01 |