Provider Demographics
NPI:1700622842
Name:GILLOOLY, KAREN
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:GILLOOLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19636 SCOTTSDALE BLVD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-6422
Mailing Address - Country:US
Mailing Address - Phone:216-548-9079
Mailing Address - Fax:
Practice Address - Street 1:19636 SCOTTSDALE BLVD
Practice Address - Street 2:
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-6422
Practice Address - Country:US
Practice Address - Phone:216-548-9079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator