Provider Demographics
NPI:1770657389
Name:ROULEAU-GERBER, GLORIA JEAN (LMSW CSW)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:JEAN
Last Name:ROULEAU-GERBER
Suffix:
Gender:F
Credentials:LMSW CSW
Other - Prefix:
Other - First Name:GLORIA
Other - Middle Name:JEAN
Other - Last Name:ROULEAU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW CSW
Mailing Address - Street 1:640 N REMPERT RD
Mailing Address - Street 2:
Mailing Address - City:TAWAS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48763-9753
Mailing Address - Country:US
Mailing Address - Phone:989-362-7215
Mailing Address - Fax:989-362-7207
Practice Address - Street 1:201 E STATE ST
Practice Address - Street 2:
Practice Address - City:EAST TAWAS
Practice Address - State:MI
Practice Address - Zip Code:48730-1333
Practice Address - Country:US
Practice Address - Phone:989-362-7215
Practice Address - Fax:989-362-7207
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010585851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801058585OtherLICENSE