1356488522 NPI number — MS. GABRIELLE DANDRIDGE PEAK MSW LCSW

Table of content: MS. GABRIELLE DANDRIDGE PEAK MSW LCSW (NPI 1356488522)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356488522 NPI number — MS. GABRIELLE DANDRIDGE PEAK MSW LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEAK
Provider First Name:
GABRIELLE
Provider Middle Name:
DANDRIDGE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW LCSW
Provider Gender Code:
F

Provider's Other Name Information

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

NPI Number Information

NPI Number:
1356488522
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:
4131 SPICEWOOD SPRINGS ROAD
Provider Second Line Business Mailing Address:
SUITE N5
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78759
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-343-2755
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4131 SPICEWOOD SPRINGS ROAD
Provider Second Line Business Practice Location Address:
SUITE N5
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78759
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-343-2755
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/30/2007

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: 1041C0700X , with the licence number:  S05570 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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