Individual
DR. PAULA W GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYCHOLOGIST
Contact information
Practice address
3970 N OAKLAND AVE, SUITE 502, SHOREWOOD, WI 53211-2265
(414) 962-9909
Mailing address
8340 W FOND DU LAC, MILWAUKEE, WI 53218-4300
(414) 462-8979
(414) 462-8985
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2738-57
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40993600
—
WI
01
—
W12670
MEDICARE PTAN
WI
Enumeration date
02/02/2007
Last updated
06/01/2012
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