1427104090 NPI number — MR. GREGG ROBERT KARLE MSW LICSW

Table of content: MR. GREGG ROBERT KARLE MSW LICSW (NPI 1427104090)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427104090 NPI number — MR. GREGG ROBERT KARLE MSW LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KARLE
Provider First Name:
GREGG
Provider Middle Name:
ROBERT
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MSW LICSW
Provider Gender Code:
M

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:
1427104090
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4700 POINT FOSDICK DR
Provider Second Line Business Mailing Address:
STE 302
Provider Business Mailing Address City Name:
GIG HARBOR
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98335-1706
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-851-3808
Provider Business Mailing Address Fax Number:
253-851-3188

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4700 POINT FOSDICK DR
Provider Second Line Business Practice Location Address:
STE 302
Provider Business Practice Location Address City Name:
GIG HARBOR
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98335-1706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-851-3808
Provider Business Practice Location Address Fax Number:
253-851-3188
Provider Enumeration Date:
01/26/2007

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: 104100000X , with the licence number:  LW00004321 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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