Most Relevant Information
Provider Data
| NPI Number: | 1003459884 |
| Provider Name: | JODY MARIE GASKILL LAC |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: | LAC-17517 |
Most Important Dates
| Enumeration Date: | 10/23/2019 |
| Last Updated: | 10/23/2019 |
Provider Practice Location
1294 FAWN BROOK DR
SHOW LOW
AZ
859017654
Practice Location Phone/Fax
| Phone: | 9285321532 |
| Fax: |
Provider Mailing Location
1294 FAWN BROOK DR
SHOW LOW
AZ
859017654
Provider Mailing Phone/Fax
| Phone: | 9285321532 |
| Fax: |