Provider Demographics
NPI:1619080512
Name:GALLAGHER, KAREN LYNN (MSW ACSW)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:LYNN
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:MSW ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-0010
Mailing Address - Country:US
Mailing Address - Phone:517-676-9788
Mailing Address - Fax:517-676-3438
Practice Address - Street 1:2289 SOWER BLVD
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-3297
Practice Address - Country:US
Practice Address - Phone:517-347-4645
Practice Address - Fax:517-347-4644
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801065439104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIR83970Medicare UPIN