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Certified Provider Details:
| PROVIDER NUMBER: | 490048 |
| AGENCY NAME: | Marshall University Social Work Dept. |
| CONTACT NAME: | Jody Gottleib |
| ADDRESS: | College of Health Professions Marshall University One John Marshall Drive |
| CITY: | Huntington |
| STATE: | WV |
| ZIP: | 25755 |
| PHONE: | |
| WEB SITE: | |
| EMAIL ADDRESS: | carterp@marshall.edu |
| BSW/MSW NAME: | Jody Gottlieb |
| DUE TO RECERTIFY DATE: | 7/1/2020 |
| COMMENTS: |