Provider Demographics
NPI:1376041467
Name:GATZKE, AIMEE
Entity Type:Individual
Prefix:MRS
First Name:AIMEE
Middle Name:
Last Name:GATZKE
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:AIMEE
Other - Middle Name:
Other - Last Name:MOLINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:520 W 4TH ST STE 2B
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-6038
Mailing Address - Country:US
Mailing Address - Phone:570-980-8716
Mailing Address - Fax:
Practice Address - Street 1:520 W 4TH ST STE 2B
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-6038
Practice Address - Country:US
Practice Address - Phone:570-980-8716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-24
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health