Provider Demographics
NPI:1730749573
Name:KOHLHOFF, GILLIAN TAYLOR (BA-SOCIAL WORK)
Entity type:Individual
Prefix:
First Name:GILLIAN
Middle Name:TAYLOR
Last Name:KOHLHOFF
Suffix:
Gender:F
Credentials:BA-SOCIAL WORK
Other - Prefix:MRS
Other - First Name:GILLIAN
Other - Middle Name:TAYLOR
Other - Last Name:KOHLHOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:199 COUNTY DF
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:WI
Mailing Address - Zip Code:53039-9512
Mailing Address - Country:US
Mailing Address - Phone:920-386-4094
Mailing Address - Fax:
Practice Address - Street 1:199 COUNTY ROAD DF
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:WI
Practice Address - Zip Code:53039-9512
Practice Address - Country:US
Practice Address - Phone:920-386-3637
Practice Address - Fax:920-386-3533
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-14
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty