Provider Demographics
NPI:1871195487
Name:POINTON, GABRIELLE E
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:E
Last Name:POINTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GABRIELLE
Other - Middle Name:E
Other - Last Name:WEBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4440 PORTAGE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46628-9570
Mailing Address - Country:US
Mailing Address - Phone:574-204-6200
Mailing Address - Fax:574-239-1520
Practice Address - Street 1:4440 PORTAGE AVE
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46628-9570
Practice Address - Country:US
Practice Address - Phone:574-204-6200
Practice Address - Fax:574-239-1520
Is Sole Proprietor?:No
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20043315A103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist