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General NPI Number Information
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NPI Number | 1184487936
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Entity Type | Individual
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Provider Name | MADELINE GEBHARD LICSW, LCSW
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Gender | Female
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Dates
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Enumeration Date | 02/05/2024
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Last Update Date | 02/05/2024
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Provider Practice Location Address
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Address Line | 10799 FALLING WATER LN UNIT D
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City | WOODBURY
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State | MN
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Zip | 55129-5263
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Country | US
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Telephone | 323-333-9511
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Fax |
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Provider Business Mailing Address
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Address Line | 10799 FALLING WATER LN UNIT D
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City | WOODBURY
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State | MN
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Zip | 55129-5263
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Country | US
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Telephone | 323-333-9511
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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 | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number | 20482
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number | CSW.09928484
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 20482
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License Number State | MN
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