1326227802 NPI number — MRS. TORRI JEAN GILLIS LCSW

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326227802 NPI number — MRS. TORRI JEAN GILLIS LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GILLIS
Provider First Name:
TORRI
Provider Middle Name:
JEAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GILLIS
Provider Other First Name:
TORRI
Provider Other Middle Name:
JEAN
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW, LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1326227802
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/26/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
504 LAKELAND ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHAWANO
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54166-6832
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-526-4700
Provider Business Mailing Address Fax Number:
715-526-5542

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
504 LAKELAND ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHAWANO
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54166-6832
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-526-4700
Provider Business Practice Location Address Fax Number:
715-526-5542
Provider Enumeration Date:
10/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  7683-123 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 40996700 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7683-123 . This is a "LCSW" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




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