Provider Demographics
NPI:1073961025
Name:GOTTLER, ALANA
Entity Type:Individual
Prefix:
First Name:ALANA
Middle Name:
Last Name:GOTTLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9385 FOLKERT RD
Mailing Address - Street 2:
Mailing Address - City:CLAY
Mailing Address - State:MI
Mailing Address - Zip Code:48001-4332
Mailing Address - Country:US
Mailing Address - Phone:810-278-3706
Mailing Address - Fax:
Practice Address - Street 1:1006 STATE ST
Practice Address - Street 2:
Practice Address - City:ALGONAC
Practice Address - State:MI
Practice Address - Zip Code:48001-1448
Practice Address - Country:US
Practice Address - Phone:810-278-3707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-01
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011157681041C0700X
247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical