Healthcare Provider Details

I. General information

NPI: 1982131108
Provider Name (Legal Business Name): GINA FLANAGAN-DREWEK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2017
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 E CASTLEBURY LN
APPLETON WI
54913-6332
US

IV. Provider business mailing address

417 E CASTLEBURY LN
APPLETON WI
54913-6332
US

V. Phone/Fax

Practice location:
  • Phone: 773-320-2694
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5659
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: