Provider Demographics
NPI:1841252590
Name:WEEKS, GAILORD C (PHD)
Entity type:Individual
Prefix:
First Name:GAILORD
Middle Name:C
Last Name:WEEKS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 S STEWART AVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:MI
Mailing Address - Zip Code:49412-9201
Mailing Address - Country:US
Mailing Address - Phone:231-924-5309
Mailing Address - Fax:231-924-1685
Practice Address - Street 1:1870 LEONARD NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505
Practice Address - Country:US
Practice Address - Phone:616-956-1122
Practice Address - Fax:616-956-8033
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301003219103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N20450023Medicare PIN