Provider Demographics
NPI:1922393990
Name:ARCHIBALD, GABRIELLE A (LISW)
Entity Type:Individual
Prefix:MRS
First Name:GABRIELLE
Middle Name:A
Last Name:ARCHIBALD
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:GABRIELLE
Other - Middle Name:
Other - Last Name:ALES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1441 W CENTRAL PARK AVE
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52804-1707
Mailing Address - Country:US
Mailing Address - Phone:563-383-1900
Mailing Address - Fax:563-884-4638
Practice Address - Street 1:1441 W CENTRAL PARK AVE
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52804-1707
Practice Address - Country:US
Practice Address - Phone:563-383-1900
Practice Address - Fax:563-884-4638
Is Sole Proprietor?:No
Enumeration Date:2011-06-17
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0072731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical