Provider Demographics
NPI:1457759565
Name:DOZIER, GLADYS FAYE (MS, SAC)
Entity type:Individual
Prefix:
First Name:GLADYS
Middle Name:FAYE
Last Name:DOZIER
Suffix:
Gender:F
Credentials:MS, SAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 W WELLS ST
Mailing Address - Street 2:SUITE 312
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53203-1866
Mailing Address - Country:US
Mailing Address - Phone:414-344-3406
Mailing Address - Fax:414-344-0107
Practice Address - Street 1:230 W WELLS ST
Practice Address - Street 2:SUITE 312
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53203-1866
Practice Address - Country:US
Practice Address - Phone:414-344-3406
Practice Address - Fax:414-344-0107
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-05
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15893131101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1457759565Medicaid