MEDICARE: GAIL J KRAWCZYK 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	104100000X	Social Worker	6723-123	WI

General Provider Information

NPI Number	:	1942245493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAIL J KRAWCZYK LCSW

Provider Business Mailing Address
First Line	:	PO BOX 25
Second Line	:
City	:	DE PERE
State	:	WI
Zip	:	54115-0025
Country	:	US
Telephone Number	:	920-983-9401
Fax Number	:	920-983-9402

Provider Business Practice Location Address
First Line	:	2631 PACKERLAND DR
Second Line	:	SUITE 104C
City	:	GREEN BAY
State	:	WI
Zip	:	54313-4130
Country	:	US
Telephone Number	:	920-965-7701
Fax Number	:	920-497-4956

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

Provider Enumeration Date	:	06/18/2006
Last Update Date	:	08/31/2009

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