Provider Demographics
NPI:1104938240
Name:SHUMAKER, GAYLE R (MA LLP)
Entity type:Individual
Prefix:MS
First Name:GAYLE
Middle Name:R
Last Name:SHUMAKER
Suffix:
Gender:F
Credentials:MA LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 HERITAGE CT
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-5481
Mailing Address - Country:US
Mailing Address - Phone:616-396-6285
Mailing Address - Fax:616-396-6172
Practice Address - Street 1:607 HERITAGE CT
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-5481
Practice Address - Country:US
Practice Address - Phone:616-396-6285
Practice Address - Fax:616-396-6172
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009247103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist