Provider Demographics
NPI:1730452160
Name:HODGES, GWEN MARIE (LSCSW)
Entity type:Individual
Prefix:
First Name:GWEN
Middle Name:MARIE
Last Name:HODGES
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2707 VINE ST STE 17
Mailing Address - Street 2:NORTHRIDGE PLAZA
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-1911
Mailing Address - Country:US
Mailing Address - Phone:785-625-2644
Mailing Address - Fax:785-625-6497
Practice Address - Street 1:2707 VINE ST STE 17
Practice Address - Street 2:NORTHRIDGE PLAZA
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-1911
Practice Address - Country:US
Practice Address - Phone:785-625-2644
Practice Address - Fax:785-625-6497
Is Sole Proprietor?:No
Enumeration Date:2012-02-15
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS39661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical