Provider Demographics
NPI:1790034205
Name:ROHDE, GAIL ANN (CSW)
Entity type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:ANN
Last Name:ROHDE
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:MISS
Other - First Name:GAIL
Other - Middle Name:ANN
Other - Last Name:GORTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSW
Mailing Address - Street 1:N85W17502 ANN AVE
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-2601
Mailing Address - Country:US
Mailing Address - Phone:262-250-8110
Mailing Address - Fax:
Practice Address - Street 1:N85W17502 ANN AVE
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-2601
Practice Address - Country:US
Practice Address - Phone:262-250-8110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3056-120104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker