1760099493 NPI number — GABRIELLE SUSANNE NEWMAN LPC-IT

Table of content: GABRIELLE SUSANNE NEWMAN LPC-IT (NPI 1760099493)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760099493 NPI number — GABRIELLE SUSANNE NEWMAN LPC-IT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEWMAN
Provider First Name:
GABRIELLE
Provider Middle Name:
SUSANNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC-IT
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:
1760099493
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/14/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1165 CLUB CIR APT 201S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKFIELD
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53005-6996
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-562-4974
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8825 S HOWELL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAK CREEK
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53154-3760
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-367-6257
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/27/2020

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: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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