=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265608129
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BREANNA N GILE PH.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/01/2008
-----------------------------------------------------
Last Update Date | 12/10/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 961 LAFAYETTE AVE
-----------------------------------------------------
City | TERRE HAUTE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47804-2929
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-462-4364
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 501 W OLIVE ST
-----------------------------------------------------
City | WEST TERRE HAUTE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47885-1822
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-462-4364
-----------------------------------------------------
Fax | 812-462-4377
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TS0200X
-----------------------------------------------------
Taxonomy Name | School Psychologist
-----------------------------------------------------
License Number | 1609587
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------