Provider Demographics
NPI:1720307580
Name:GOTTSCHALK, CARRIE LEIGH
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:LEIGH
Last Name:GOTTSCHALK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2258 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SEWARD
Mailing Address - State:NE
Mailing Address - Zip Code:68434-6016
Mailing Address - Country:US
Mailing Address - Phone:402-515-3312
Mailing Address - Fax:
Practice Address - Street 1:2258 N 1ST ST
Practice Address - Street 2:
Practice Address - City:SEWARD
Practice Address - State:NE
Practice Address - Zip Code:68434-6016
Practice Address - Country:US
Practice Address - Phone:402-515-3312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-19
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3219101YM0800X
NE4029101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health