Provider Demographics
NPI:1245304179
Name:PRICE, GAIL H (LCSW)
Entity type:Individual
Prefix:MS
First Name:GAIL
Middle Name:H
Last Name:PRICE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2614 WAUNONA WAY
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-1525
Mailing Address - Country:US
Mailing Address - Phone:608-221-3277
Mailing Address - Fax:
Practice Address - Street 1:406 N PINCKNEY ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-1410
Practice Address - Country:US
Practice Address - Phone:608-255-8838
Practice Address - Fax:608-255-8837
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2061101YA0400X
WI2468-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39503800Medicaid
WI2468-123OtherLCSW
WI2061OtherCADC III
WI39503800Medicaid