Provider Demographics
NPI:1447677968
Name:ROTTMAN, GAIL ANNE (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:ANNE
Last Name:ROTTMAN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 N ROYAL AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-7845
Mailing Address - Country:US
Mailing Address - Phone:812-402-0020
Mailing Address - Fax:
Practice Address - Street 1:1101 N ROYAL AVE
Practice Address - Street 2:SUITE B
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-7845
Practice Address - Country:US
Practice Address - Phone:812-402-0020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-21
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34006783A1041C0700X
KY37761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000868246OtherANTHEM
IN12664050OtherCAQH
IN139660007Medicare PIN