Provider Demographics
NPI:1881615185
Name:SCHAPER-GORDON, GAIL L (PHD,)
Entity type:Individual
Prefix:DR
First Name:GAIL
Middle Name:L
Last Name:SCHAPER-GORDON
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 1:1912 KAWEAH DR
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3604
Mailing Address - Country:US
Mailing Address - Phone:323-259-9449
Mailing Address - Fax:323-344-0008
Practice Address - Street 1:4529 ANGELES CREST HWY
Practice Address - Street 2:SUITE 205
Practice Address - City:LA CANADA
Practice Address - State:CA
Practice Address - Zip Code:91011-3247
Practice Address - Country:US
Practice Address - Phone:818-368-0079
Practice Address - Fax:323-344-0008
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8898103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP8898AMedicare ID - Type UnspecifiedNHIC (MEDICARE)
CAV6F003Medicare UPIN
CA00PL88981Medicare UPIN