MEDICARE: CATHERINE ANN GALLAGHER LPC

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1437413259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE ANN GALLAGHER LPC

Provider Business Mailing Address
First Line	:	503 WISCONSIN AVE
Second Line	:
City	:	SHEBOYGAN
State	:	WI
Zip	:	53081-4147
Country	:	US
Telephone Number	:	920-458-5726
Fax Number	:	920-458-5826

Provider Business Practice Location Address
First Line	:	503 WISCONSIN AVE
Second Line	:
City	:	SHEBOYGAN
State	:	WI
Zip	:	53081-4147
Country	:	US
Telephone Number	:	920-458-5726
Fax Number	:	920-458-5826

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

Provider Enumeration Date	:	06/26/2012
Last Update Date	:	04/17/2017

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