MEDICARE: GAHLYA AUEL ED.S, NCSP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TS0200X	School Psychologist	474896H	WA

General Provider Information

NPI Number	:	1114278223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAHLYA AUEL ED.S, NCSP

Provider Business Mailing Address
First Line	:	110 E SPENCER LAKE RD
Second Line	:
City	:	SHELTON
State	:	WA
Zip	:	98584-7307
Country	:	US
Telephone Number	:	360-427-2931
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 E SPENCER LAKE RD
Second Line	:
City	:	SHELTON
State	:	WA
Zip	:	98584-7307
Country	:	US
Telephone Number	:	360-427-2931
Fax Number	:	360-427-2933

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2012
Last Update Date	:	01/08/2014

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