Provider Demographics
NPI:1104067511
Name:GANCI, CHERYL ANN (MA, LMFT)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:ANN
Last Name:GANCI
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:MRS
Other - First Name:CHERYLANN
Other - Middle Name:
Other - Last Name:GANCI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LMFT
Mailing Address - Street 1:3228 FOREST RUN CT
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-7762
Mailing Address - Country:US
Mailing Address - Phone:608-381-8423
Mailing Address - Fax:855-210-3522
Practice Address - Street 1:111 S 1ST ST
Practice Address - Street 2:SUITE 120
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-5236
Practice Address - Country:US
Practice Address - Phone:608-381-8423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-13
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1959106H00000X
WI973-124106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist