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General NPI Number Information
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NPI Number | 1003995663
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Entity Type | Individual
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Provider Name | KAREN SUE GAGE M.S.W., C.I.S.W.
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Gender | Female
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Dates
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Enumeration Date | 11/03/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5000 W NATIONAL AVE ROOM 8221
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City | MILWAUKEE
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State | WI
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Zip | 53295-0001
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Country | US
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Telephone | 414-384-2000
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Fax |
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Provider Business Mailing Address
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Address Line | N49W31212 OLD STEEPLE RD
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City | HARTLAND
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State | WI
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Zip | 53029-8532
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Country | US
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Telephone | 414-384-2000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 908-122
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License Number State | WI
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