Provider Demographics
NPI:1285658179
Name:HERMAN, GAYLE LINDSAY SLATEN (MS, MFT)
Entity Type:Individual
Prefix:MRS
First Name:GAYLE
Middle Name:LINDSAY SLATEN
Last Name:HERMAN
Suffix:
Gender:F
Credentials:MS, MFT
Other - Prefix:MS
Other - First Name:GAYLE
Other - Middle Name:LINDSAY
Other - Last Name:BARONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, MFT
Mailing Address - Street 1:209 W HERRON BOULEVARD KP N
Mailing Address - Street 2:
Mailing Address - City:LAKEBAY
Mailing Address - State:WA
Mailing Address - Zip Code:98349-8186
Mailing Address - Country:US
Mailing Address - Phone:916-783-7254
Mailing Address - Fax:253-884-1248
Practice Address - Street 1:209 W HERRON BOULEVARD KP N
Practice Address - Street 2:
Practice Address - City:LAKEBAY
Practice Address - State:WA
Practice Address - Zip Code:98349-8186
Practice Address - Country:US
Practice Address - Phone:916-783-7254
Practice Address - Fax:253-884-1248
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC24750106H00000X
WALF00002663106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA137329OtherVALUE OPTIONS
CA1021-02OtherPACIFICARE
CAZZZ56345ZOtherBLUE SHIELD
CA0001067987OtherMHN