Healthcare Provider Details

I. General information

NPI: 1093602518
Provider Name (Legal Business Name): SYLVIA M GATES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2025
Last Update Date: 06/18/2025
Certification Date: 05/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4431 N 49TH ST CARETOLOVE33@GMAIL.COM
MILWAUKEE WI
53218-5321
US

IV. Provider business mailing address

4431 N 49TH ST
MILWAUKEE WI
53218-5702
US

V. Phone/Fax

Practice location:
  • Phone: 414-507-8627
  • Fax:
Mailing address:
  • Phone: 414-507-8627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: