Healthcare Provider Details

I. General information

NPI: 1003145384
Provider Name (Legal Business Name): GAIL BIALK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GAIL YAUNKE

II. Dates (important events)

Enumeration Date: 12/15/2009
Last Update Date: 05/06/2021
Certification Date: 05/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12791 WORLD PLAZA LN BLDG 89
FORT MYERS FL
33907-3989
US

IV. Provider business mailing address

12791 WORLD PLAZA LN BLDG 89
FORT MYERS FL
33907-3989
US

V. Phone/Fax

Practice location:
  • Phone: 239-829-5494
  • Fax: 239-645-4777
Mailing address:
  • Phone: 239-829-5494
  • Fax: 239-645-4777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW13749
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number127934-121
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: