Provider Demographics
NPI:1891595716
Name:GAYMAN, MICHAEL JR (ICADC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:GAYMAN
Suffix:JR
Gender:
Credentials:ICADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 BRADY ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-4603
Mailing Address - Country:US
Mailing Address - Phone:563-505-5621
Mailing Address - Fax:
Practice Address - Street 1:1411 BRADY ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-4603
Practice Address - Country:US
Practice Address - Phone:563-505-5621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA25R501101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)