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General NPI Number Information
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NPI Number | 1780724328
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Entity Type | Organization
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Legal Business Name | JOHN GILANE MSW CADC III
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 06/27/2012
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Provider Practice Location Address
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Address Line | 10144 N PORT WASHINGTON RD STE LL-B
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City | MEQUON
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State | WI
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Zip | 53092-5796
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Country | US
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Telephone | 262-240-1240
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Fax |
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Provider Business Mailing Address
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Address Line | 10144 N PORT WASHINGTON RD STE LL-B
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City | MEQUON
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State | WI
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Zip | 53092-5796
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOHN GILANE
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Credential |
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Telephone | 262-240-1240
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 2523
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License Number State | WI
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