Most Relevant Information
Provider Data
| NPI Number: | 1003659368 |
| Provider Name: | GYPSY GILLUM |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 06/14/2024 |
| Last Updated: | 06/14/2024 |
Provider Practice Location
291 E SWANSON AVE
WASILLA
AK
996547004
Practice Location Phone/Fax
| Phone: | 9073763275 |
| Fax: |
Provider Mailing Location
291 E SWANSON AVE
WASILLA
AK
996547004
Provider Mailing Phone/Fax
| Phone: | 9073763275 |
| Fax: |