Provider Demographics
NPI:1598985053
Name:HALSELL, GWENDOLYN DENISE
Entity Type:Individual
Prefix:MS
First Name:GWENDOLYN
Middle Name:DENISE
Last Name:HALSELL
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 1:3541 WHITNEY AVE
Mailing Address - Street 2:#203
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-3165
Mailing Address - Country:US
Mailing Address - Phone:916-370-1944
Mailing Address - Fax:
Practice Address - Street 1:3727 MARCONI AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-5303
Practice Address - Country:US
Practice Address - Phone:916-485-6500
Practice Address - Fax:916-485-6814
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator