Provider Demographics
NPI:1871738633
Name:GAMEZ, JILL M (SAC)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:M
Last Name:GAMEZ
Suffix:
Gender:F
Credentials:SAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N6789 410TH ST
Mailing Address - Street 2:
Mailing Address - City:MENOMONIE
Mailing Address - State:WI
Mailing Address - Zip Code:54751-4945
Mailing Address - Country:US
Mailing Address - Phone:715-235-9346
Mailing Address - Fax:
Practice Address - Street 1:320 21ST ST N
Practice Address - Street 2:
Practice Address - City:MENOMONIE
Practice Address - State:WI
Practice Address - Zip Code:54751-2228
Practice Address - Country:US
Practice Address - Phone:715-235-4537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-09
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15396-131101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)