Provider Demographics
NPI:1922328368
Name:GILBERT, MARKEENA LANAE (MS)
Entity Type:Individual
Prefix:MS
First Name:MARKEENA
Middle Name:LANAE
Last Name:GILBERT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6878 N TEUTONIA AVE UPPR
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-2515
Mailing Address - Country:US
Mailing Address - Phone:414-540-6347
Mailing Address - Fax:414-540-6347
Practice Address - Street 1:10045 W LISBON AVE
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53222-2446
Practice Address - Country:US
Practice Address - Phone:414-358-7999
Practice Address - Fax:414-358-7158
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-08
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI4548-125OtherLPC