Provider Demographics
NPI:1699395699
Name:VEENSTRA, GAIL LILLIAN
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:LILLIAN
Last Name:VEENSTRA
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 1:18228 WINDSOR HILL DR
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1477
Mailing Address - Country:US
Mailing Address - Phone:240-751-6819
Mailing Address - Fax:
Practice Address - Street 1:1610 S ROLLING RD APT C
Practice Address - Street 2:
Practice Address - City:HALETHORPE
Practice Address - State:MD
Practice Address - Zip Code:21227-4232
Practice Address - Country:US
Practice Address - Phone:240-751-6819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-20
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician