Provider Demographics
NPI:1336283688
Name:CHEESMAN, GAIL EVERNDEN (LCSW, MSSW)
Entity Type:Individual
Prefix:MS
First Name:GAIL
Middle Name:EVERNDEN
Last Name:CHEESMAN
Suffix:
Gender:F
Credentials:LCSW, MSSW
Other - Prefix:MS
Other - First Name:GAIL
Other - Middle Name:E
Other - Last Name:CHEESMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW, MSSW
Mailing Address - Street 1:2501 S 60TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53219-2621
Mailing Address - Country:US
Mailing Address - Phone:414-659-4098
Mailing Address - Fax:
Practice Address - Street 1:5151 W SILVER SPRING DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218-3300
Practice Address - Country:US
Practice Address - Phone:414-527-6970
Practice Address - Fax:414-527-6971
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7023-1231041C0700X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40905300Medicaid