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NPI Code Detail

MEDICARE: GINA MICKLE

MEDICARE: GINA MICKLE
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
1101Y00000XCounselorCG61202664WA
2104100000XSocial WorkerSC61676722WA

General Provider Information

NPI Number : 1992446223
Entity Type Code : Individual
Provider Name (Legal Business Name) : GINA MICKLE
Provider Business Mailing Address
First Line : 325 W GOWE ST
Second Line :
City : KENT
State : WA
Zip : 98032-5892
Country : US
Telephone Number : 253-833-7444
Fax Number : 253-661-8631
Provider Business Practice Location Address
First Line : 2704 I ST NE
Second Line :
City : AUBURN
State : WA
Zip : 98002-2411
Country : US
Telephone Number : 253-833-7444
Fax Number : 253-661-8631
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/01/2022
Last Update Date : 02/09/2026

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Directions to “ GINA MICKLE ” Practice Location

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