Provider Demographics
NPI:1760549513
Name:FLANAGAN, GERALD D (MS CADCIII CCSII)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:D
Last Name:FLANAGAN
Suffix:
Gender:M
Credentials:MS CADCIII CCSII
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:18705 BROOKRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-1029
Mailing Address - Country:US
Mailing Address - Phone:262-896-0905
Mailing Address - Fax:262-781-6603
Practice Address - Street 1:300 COTTONWOOD AVE STE 4
Practice Address - Street 2:
Practice Address - City:HARTLAND
Practice Address - State:WI
Practice Address - Zip Code:53029-2043
Practice Address - Country:US
Practice Address - Phone:262-896-0905
Practice Address - Fax:262-781-6603
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI811 AND 7059101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)