Provider Demographics
NPI:1679720650
Name:METALSKY, GERALD IKE (PHD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:IKE
Last Name:METALSKY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:JERALD
Other - Middle Name:IKE
Other - Last Name:METALSKY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:103 W COLLEGE AVE
Mailing Address - Street 2:SUITE 1125
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-5770
Mailing Address - Country:US
Mailing Address - Phone:920-730-1088
Mailing Address - Fax:
Practice Address - Street 1:103 W COLLEGE AVE
Practice Address - Street 2:SUITE 1125
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-5770
Practice Address - Country:US
Practice Address - Phone:920-730-1088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2552103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical