Provider Demographics
NPI:1861819534
Name:YAUCK, GINA
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:YAUCK
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 1:10850 W PARK PL STE 100
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53224-3636
Mailing Address - Country:US
Mailing Address - Phone:262-789-1191
Mailing Address - Fax:414-359-1021
Practice Address - Street 1:10850 W PARK PL STE 100
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53224-3636
Practice Address - Country:US
Practice Address - Phone:262-789-1191
Practice Address - Fax:414-359-1021
Is Sole Proprietor?:No
Enumeration Date:2014-03-19
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8145-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical