Provider Demographics
NPI:1902349582
Name:UNICI, GORDANA (MA)
Entity type:Individual
Prefix:MISS
First Name:GORDANA
Middle Name:
Last Name:UNICI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1712 HIGHWAY 121 BYP N STE I
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-8864
Mailing Address - Country:US
Mailing Address - Phone:270-761-5804
Mailing Address - Fax:270-761-5807
Practice Address - Street 1:1712 HIGHWAY 121 BYP N STE I
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-8864
Practice Address - Country:US
Practice Address - Phone:270-761-5804
Practice Address - Fax:270-761-5807
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-30
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1114101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100643330Medicaid