Provider Demographics
NPI:1184750721
Name:WAHL, GAIL LOREE (PHD)
Entity type:Individual
Prefix:DR
First Name:GAIL
Middle Name:LOREE
Last Name:WAHL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 CENTRAL AVE
Mailing Address - Street 2:SUITE 514
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-2272
Mailing Address - Country:US
Mailing Address - Phone:541-269-1749
Mailing Address - Fax:541-269-1749
Practice Address - Street 1:320 CENTRAL AVE
Practice Address - Street 2:SUITE 514
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-2272
Practice Address - Country:US
Practice Address - Phone:541-269-1749
Practice Address - Fax:541-269-1749
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR256103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical