Provider Demographics
NPI:1427104090
Name:KARLE, GREGG ROBERT (MSW LICSW)
Entity type:Individual
Prefix:MR
First Name:GREGG
Middle Name:ROBERT
Last Name:KARLE
Suffix:
Gender:M
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 POINT FOSDICK DR
Mailing Address - Street 2:STE 302
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1706
Mailing Address - Country:US
Mailing Address - Phone:253-851-3808
Mailing Address - Fax:253-851-3188
Practice Address - Street 1:4700 POINT FOSDICK DR
Practice Address - Street 2:STE 302
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1706
Practice Address - Country:US
Practice Address - Phone:253-851-3808
Practice Address - Fax:253-851-3188
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW00004321104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
G001002037Medicare ID - Type Unspecified