Provider Demographics
NPI:1104174689
Name:GAMBILL, SARAH LYNN (LMSW)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:LYNN
Last Name:GAMBILL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 LAKEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-2379
Mailing Address - Country:US
Mailing Address - Phone:269-408-4344
Mailing Address - Fax:
Practice Address - Street 1:2900 LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-2379
Practice Address - Country:US
Practice Address - Phone:269-408-4344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010931111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical