Provider Demographics
NPI:1184340739
Name:BACIS, GAIL LYNN (MSW)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:LYNN
Last Name:BACIS
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 1:801 INVERNESS PL
Mailing Address - Street 2:
Mailing Address - City:FORT THOMAS
Mailing Address - State:KY
Mailing Address - Zip Code:41075-1362
Mailing Address - Country:US
Mailing Address - Phone:859-866-7967
Mailing Address - Fax:
Practice Address - Street 1:801 INVERNESS PL
Practice Address - Street 2:
Practice Address - City:FORT THOMAS
Practice Address - State:KY
Practice Address - Zip Code:41075-1362
Practice Address - Country:US
Practice Address - Phone:859-866-7967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care