Provider Demographics
NPI:1730300096
Name:GEHL, GWENDOLYN (LCSW)
Entity Type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:
Last Name:GEHL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N2735 FOX RD
Mailing Address - Street 2:
Mailing Address - City:NEOSHO
Mailing Address - State:WI
Mailing Address - Zip Code:53059-9786
Mailing Address - Country:US
Mailing Address - Phone:920-625-3070
Mailing Address - Fax:
Practice Address - Street 1:N2735 FOX RD
Practice Address - Street 2:
Practice Address - City:NEOSHO
Practice Address - State:WI
Practice Address - Zip Code:53059-9786
Practice Address - Country:US
Practice Address - Phone:920-625-3070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2012-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical