Individual
KEITH D GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
1969 W HART RD, BELOIT, WI 53511-2230
(608) 364-5686
(608) 363-5756
Mailing address
N2788 WALDEN LN, LAKE GENEVA, WI 53147-3439
(262) 248-6789
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
522057
WI
Other
Enumeration date
04/23/2007
Last updated
07/08/2007
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