Provider Demographics
NPI:1225179294
Name:GASER, THERESA J (LSW, MSSA)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:J
Last Name:GASER
Suffix:
Gender:F
Credentials:LSW, MSSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 E CAMPUS VIEW BLVD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-5616
Mailing Address - Country:US
Mailing Address - Phone:614-310-1234
Mailing Address - Fax:614-310-1237
Practice Address - Street 1:355 E CAMPUS VIEW BLVD
Practice Address - Street 2:SUITE 240
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-5616
Practice Address - Country:US
Practice Address - Phone:614-310-1234
Practice Address - Fax:614-310-1237
Is Sole Proprietor?:No
Enumeration Date:2007-02-10
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS-32039101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSW36781Medicare PIN