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NPI Code Detail

MEDICARE: DR. GAIL YVONNE PICKETT PHD

MEDICARE: DR. GAIL YVONNE PICKETT PHD
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
1103TC0700XClinical Psychologist337ND

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2260043017OTHERNDRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1018708OTHERNDBCBS PROVIDER NUMBER

General Provider Information

NPI Number : 1235177841
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GAIL YVONNE PICKETT PHD
Provider Business Mailing Address
First Line : 1219 WASHINGTON AVE
Second Line :
City : DETROIT LAKES
State : MN
Zip : 56501-3905
Country : US
Telephone Number : 218-846-2244
Fax Number :
Provider Business Practice Location Address
First Line : 1219 WASHINGTON AVE
Second Line :
City : DETROIT LAKES
State : MN
Zip : 56501-3905
Country : US
Telephone Number : 218-846-2244
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/04/2006
Last Update Date : 03/25/2022

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