1356417018 NPI number — MS. GAYLE L PIERCE LPC CADC III

Table of content: MS. GAYLE L PIERCE LPC CADC III (NPI 1356417018)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356417018 NPI number — MS. GAYLE L PIERCE LPC CADC III

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PIERCE
Provider First Name:
GAYLE
Provider Middle Name:
L
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LPC CADC III
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
IRSCH
Provider Other First Name:
GAYLE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1356417018
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
N8459 FIR RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILLIPS
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54555
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-339-4592
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
804 W 9TH ST N SUITE B
Provider Second Line Business Practice Location Address:
AURORA COMMUNITY COUNSELING EMPLOYEE SUPPORT & SERVICES
Provider Business Practice Location Address City Name:
LADYSMITH
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54848
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-532-9771
Provider Business Practice Location Address Fax Number:
715-532-9774
Provider Enumeration Date:
11/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  1323125 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 39751600 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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