AMANDA PAULETTE GANNON LMSW NPI 1285234419

NPI Information

  • NPI: 1285234419
  • Provider Name: AMANDA PAULETTE GANNON, LMSW
  • Classification: Counselor - 101YM0800X
  • Specialization: Mental Health
  • Entity Type: Individual
  • Address: 344 FRONT ST STE A
    KETCHIKAN, AK
    ZIP 99901
  • Phone: (572) 999-0107

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NPI Details

Amanda Paulette Gannon, LMSW is a mental health counselor in Ketchikan, AK. Amanda Paulette Gannon, LMSW NPI is 1285234419. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

344 FRONT ST STE A
KETCHIKAN, AK
ZIP 99901-431
Phone: (572) 999-0107

The enumeration date for this NPI number is 10/27/2020 and was last updated on 8/1/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1104100000XSocial Worker215055ALASKANo
2101YM0800XCounselorMental Health215055ALASKAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11366719759MEDICAIDALASKA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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