Provider Demographics
NPI:1003807504
Name:DUKART-HARDY, GAYLE (MSW)
Entity type:Individual
Prefix:
First Name:GAYLE
Middle Name:
Last Name:DUKART-HARDY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 NE ANDRESEN RD
Mailing Address - Street 2:SUITE D-9
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-7347
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2700 NE ANDRESEN RD
Practice Address - Street 2:SUITE D-9
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-7347
Practice Address - Country:US
Practice Address - Phone:360-694-8558
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000059971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB00418Medicare ID - Type Unspecified