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NPI Code Detail

MEDICARE: MRS. TERRILYNNE GAUSE MSW

MEDICARE: MRS. TERRILYNNE GAUSE MSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker
21041C0700XClinical Social Worker

General Provider Information

NPI Number : 1457602500
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TERRILYNNE GAUSE MSW
Provider Business Mailing Address
First Line : 6309 MACK AVE
Second Line :
City : DETROIT
State : MI
Zip : 48207-2302
Country : US
Telephone Number : 313-921-4700
Fax Number :
Provider Business Practice Location Address
First Line : 6309 MACK AVE
Second Line :
City : DETROIT
State : MI
Zip : 48207-2302
Country : US
Telephone Number : 313-921-4700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/28/2012
Last Update Date : 12/09/2025

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