Individual
MR. GARY W MIJAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
7617 MINERAL POINT RD, STE 300, MADISON, WI 53717-1623
(608) 833-9290
(608) 833-9691
Mailing address
7617 MINERAL POINT RD, STE 300, MADISON, WI 53717-1623
(608) 833-9290
(608) 833-9691
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
674-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12761
DEAN
WI
01
—
391627035010
BLUE CROSS/BLUE SHIELD
WI
05
—
39518100
—
WI
Enumeration date
07/07/2006
Last updated
01/19/2011
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