Provider Demographics
NPI:1689996324
Name:QUIGLEY, GISELLA SUZANNE (LMSW)
Entity Type:Individual
Prefix:
First Name:GISELLA
Middle Name:SUZANNE
Last Name:QUIGLEY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 HOMER DR
Mailing Address - Street 2:
Mailing Address - City:ST MARIES
Mailing Address - State:ID
Mailing Address - Zip Code:83861-5078
Mailing Address - Country:US
Mailing Address - Phone:208-245-5427
Mailing Address - Fax:208-245-5425
Practice Address - Street 1:89 HOMER DR
Practice Address - Street 2:
Practice Address - City:ST MARIES
Practice Address - State:ID
Practice Address - Zip Code:83861-5078
Practice Address - Country:US
Practice Address - Phone:208-245-5427
Practice Address - Fax:208-245-5425
Is Sole Proprietor?:No
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-30022104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker