Provider Demographics
NPI:1609318823
Name:GECKELER, NICOLE
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:GECKELER
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 1:1821 TENNESSEE ST
Mailing Address - Street 2:APT 2
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-4179
Mailing Address - Country:US
Mailing Address - Phone:760-807-0709
Mailing Address - Fax:
Practice Address - Street 1:1821 TENNESSEE ST
Practice Address - Street 2:APT 2
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-4179
Practice Address - Country:US
Practice Address - Phone:760-807-0709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-07
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician