MEDICARE: CARL GAEDE LCSW

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	1041C0700X	Clinical Social Worker	6615-123	WI

General Provider Information

NPI Number	:	1831316025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARL GAEDE LCSW

Provider Business Mailing Address
First Line	:	PO BOX 214
Second Line	:
City	:	NEW RICHMOND
State	:	WI
Zip	:	54017-0214
Country	:	US
Telephone Number	:	715-222-6028
Fax Number	:

Provider Business Practice Location Address
First Line	:	1935 COUNTY ROAD B2 W STE 270
Second Line	:
City	:	ROSEVILLE
State	:	MN
Zip	:	55113-2785
Country	:	US
Telephone Number	:	715-222-6028
Fax Number	:

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

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	04/24/2019

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