Provider Demographics
NPI:1861407660
Name:HANGIANDREOU, GABRIELLA ANN (MD)
Entity type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:ANN
Last Name:HANGIANDREOU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 S 24TH AVE
Mailing Address - Street 2:CHW COMMUNITY SERVICES CHILD AND FAMILY COUNSELING
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-5242
Mailing Address - Country:US
Mailing Address - Phone:715-848-1457
Mailing Address - Fax:715-848-2959
Practice Address - Street 1:705 S 24TH AVE
Practice Address - Street 2:CHW COMMUNITY SERVICES CHILD AND FAMILY COUNSELING
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-5242
Practice Address - Country:US
Practice Address - Phone:715-848-1457
Practice Address - Fax:715-848-2959
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI35579-0202084P0804X
WI355792084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32501200Medicaid
WI1861407660Medicaid
WI35579-20OtherWI STATE LICENSE
WI1861407660Medicaid