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NPI Code Detail

MEDICARE: GALE ZICCARELLI MSW

MEDICARE: GALE ZICCARELLI MSW
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
11041C0700XClinical Social Worker7129-123WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1568578912
Entity Type Code : Individual
Provider Name (Legal Business Name) : GALE ZICCARELLI MSW
Provider Business Mailing Address
First Line : 6233 39TH AVE
Second Line :
City : KENOSHA
State : WI
Zip : 53142-7015
Country : US
Telephone Number : 262-654-1004
Fax Number : 262-654-6960
Provider Business Practice Location Address
First Line : 2108 63RD ST
Second Line :
City : KENOSHA
State : WI
Zip : 53143-4454
Country : US
Telephone Number : 262-652-2406
Fax Number : 262-652-2408
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2006
Last Update Date : 06/30/2008

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