Provider Demographics
NPI:1679836274
Name:GANDIAGA, KARLA RUTH (PCSW)
Entity type:Individual
Prefix:
First Name:KARLA
Middle Name:RUTH
Last Name:GANDIAGA
Suffix:
Gender:F
Credentials:PCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 MAGNOLIA CIR
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-4378
Mailing Address - Country:US
Mailing Address - Phone:307-871-6239
Mailing Address - Fax:
Practice Address - Street 1:2300 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-5610
Practice Address - Country:US
Practice Address - Phone:307-352-6677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPCSW-5031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical