Provider Demographics
NPI:1538341433
Name:GEHANT, MAVIS (CSW PIP)
Entity type:Individual
Prefix:
First Name:MAVIS
Middle Name:
Last Name:GEHANT
Suffix:
Gender:F
Credentials:CSW PIP
Other - Prefix:
Other - First Name:MAVIS
Other - Middle Name:
Other - Last Name:MARQUARDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSW PIP
Mailing Address - Street 1:1212 E COLLEGE DR
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MN
Mailing Address - Zip Code:56258-2010
Mailing Address - Country:US
Mailing Address - Phone:507-532-3236
Mailing Address - Fax:507-532-0240
Practice Address - Street 1:1212 E COLLEGE DR
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MN
Practice Address - Zip Code:56258-2010
Practice Address - Country:US
Practice Address - Phone:507-532-3236
Practice Address - Fax:507-532-0240
Is Sole Proprietor?:No
Enumeration Date:2007-12-03
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CSWPIP2292104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker