Healthcare Provider Details

I. General information

NPI: 1992612741
Provider Name (Legal Business Name): SIOBHAN GAVAGAN ED.S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 W HOPE AVE
MILWAUKEE WI
53216-1761
US

IV. Provider business mailing address

356 E OKLAHOMA AVE APT 4
MILWAUKEE WI
53207-2656
US

V. Phone/Fax

Practice location:
  • Phone: 414-875-6300
  • Fax:
Mailing address:
  • Phone: 631-942-6390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: