Healthcare Provider Details

I. General information

NPI: 1255870895
Provider Name (Legal Business Name): GAIL GIOVANNELLI LLBSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2017
Last Update Date: 02/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 ORLEANS BLVD
COLDWATER MI
49036-1767
US

IV. Provider business mailing address

200 ORLEANS BLVD
COLDWATER MI
49036-1767
US

V. Phone/Fax

Practice location:
  • Phone: 517-278-2129
  • Fax: 517-279-8172
Mailing address:
  • Phone: 517-278-2129
  • Fax: 517-279-8172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number6802089250
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: