Provider Demographics
NPI:1831316025
Name:GAEDE, CARL (LCSW)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:
Last Name:GAEDE
Suffix:
Gender:M
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:PO BOX 214
Mailing Address - Street 2:
Mailing Address - City:NEW RICHMOND
Mailing Address - State:WI
Mailing Address - Zip Code:54017-0214
Mailing Address - Country:US
Mailing Address - Phone:715-222-6028
Mailing Address - Fax:
Practice Address - Street 1:1935 COUNTY ROAD B2 W STE 270
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-2785
Practice Address - Country:US
Practice Address - Phone:715-222-6028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6615-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical