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NPI Code Detail

MEDICARE: MS. INGRID E. GOMEZ APSW, SAC-IT

MEDICARE: MS. INGRID E. GOMEZ APSW, SAC-IT
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
1101Y00000XCounselor15576-130WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1127821-121OTHERWIAPSW
215576-130OTHERWISAC-IT

General Provider Information

NPI Number : 1669787800
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. INGRID E. GOMEZ APSW, SAC-IT
Provider Business Mailing Address
First Line : 2625 N WEIL ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53212-3060
Country : US
Telephone Number : 414-962-1200
Fax Number : 414-962-2305
Provider Business Practice Location Address
First Line : 2625 N WEIL ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53212-3060
Country : US
Telephone Number : 414-962-1200
Fax Number : 414-962-2305
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/12/2010
Last Update Date : 08/12/2010

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