Provider Demographics
NPI:1629778683
Name:GASDE, IRENE (MS, MIM, QMHP)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:GASDE
Suffix:
Gender:F
Credentials:MS, MIM, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 HOLLY ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-2928
Mailing Address - Country:US
Mailing Address - Phone:541-301-6474
Mailing Address - Fax:
Practice Address - Street 1:328 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-7274
Practice Address - Country:US
Practice Address - Phone:541-301-6474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health