1912005364 NPI number — MISS GALE WARDELL

Table of content: MISS GALE WARDELL (NPI 1912005364)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912005364 NPI number — MISS GALE WARDELL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WARDELL
Provider First Name:
GALE
Provider Middle Name:
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JOHNSON
Provider Other First Name:
GALE
Provider Other Middle Name:
W
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSSW,LCSW,BCD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1912005364
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:
1338 PAPERMILL POINTE WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-558-3011
Provider Business Mailing Address Fax Number:
865-588-3851

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1338 PAPERMILL POINTE WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-558-3011
Provider Business Practice Location Address Fax Number:
865-588-3851
Provider Enumeration Date:
09/20/2006

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: 1041C0700X , with the licence number:  386 LCSW , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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