Healthcare Provider Details

I. General information

NPI: 1194982355
Provider Name (Legal Business Name): GALE ANN BEACH MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2008
Last Update Date: 05/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 W WOOD
NEWAYGO MI
49337
US

IV. Provider business mailing address

12 W WOOD
NEWAYGO MI
49337
US

V. Phone/Fax

Practice location:
  • Phone: 231-652-1780
  • Fax: 231-652-1786
Mailing address:
  • Phone: 231-652-1780
  • Fax: 231-652-1786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801078857
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: