Healthcare Provider Details

I. General information

NPI: 1366353948
Provider Name (Legal Business Name): STACEY GAULE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 E OHIO ST
MARQUETTE MI
49855-3847
US

IV. Provider business mailing address

1510 WOODLAND AVE
MARQUETTE MI
49855-1512
US

V. Phone/Fax

Practice location:
  • Phone: 906-226-5100
  • Fax:
Mailing address:
  • Phone: 715-938-3321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberSP0000001018057
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: