Provider Demographics
NPI:1316083686
Name:GIBEAU, PAUL M (PSYD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:M
Last Name:GIBEAU
Suffix:
Gender:M
Credentials:PSYD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:14135 N CEDARBURG RD
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53097-1416
Mailing Address - Country:US
Mailing Address - Phone:262-377-2006
Mailing Address - Fax:262-377-5552
Practice Address - Street 1:14135 N CEDARBURG RD
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53097-1416
Practice Address - Country:US
Practice Address - Phone:262-377-2006
Practice Address - Fax:262-377-5552
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2344057103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P50914Medicare UPIN