DR. MICHAEL WALSH GANNON (NPI# 1962809699) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1962809699 |
Entity Type | Individual |
Full Name | DR. MICHAEL WALSH GANNON |
Credential | PH.D., L.C.A.D.C. |
Practice Address |
109 Cloud Touch Ct Roseville CA 95747-7116 |
Practice Telephone | 9163185317 |
Mailing Telephone | 9163185317 |
Enumeration Date | 2014-11-24 |
Last Update Date | 2016-11-18 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
167168 | KY | Behavioral Health & Social Service Providers |
N | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
1340 | KY | Behavioral Health & Social Service Providers |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1033623111 | Michael James Gannon | Pharmacist | 833 S Wood St Fl 3, Chicago, IL 60612-7229 | 2017-11-27 |
1225441215 | Michael Gannon | Family Medicine | 2531 Landmark Dr Ste 103, Clearwater, FL 33761-3928 | 2014-06-06 |
1194086041 | Michael Patrick Gannon | Internal Medicine | 3509 N Broad St, Philadelphia, PA 19140-4105 | 2012-06-06 |
1366582710 | Michael J Gannon | Internal Medicine | 2741 Wheaton Way, Bremerton, WA 98310-3344 | 2007-02-07 |
1316096480 | Michael Lawrence Gannon | Dentist | 138 Church St Ne, Vienna, VA 22180-4543 | 2007-01-09 |
1790704856 | Michael Kevin Gannon | Orthopaedic Surgery | 2979 Squalicum Pkwy, Suite #203, Bellingham, WA 98225-1811 | 2006-07-19 |
1528060654 | Michael James Gannon | Family Medicine | 11452 Space Center Blvd, Houston, TX 77059 | 2005-08-10 |
Street Address |
109 CLOUD TOUCH CT |
City | ROSEVILLE |
State | CA |
Zip Code | 95747-7116 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1215407051 | Clifford Leo Faubert | Nurse Practitioner | 1937 Ellesmere Loop, Roseville, CA 95747 | 2018-12-04 |
1821577172 | Adam Botwinik | Psychologist | 8849 Cook Riolo Road, Roseville, CA 95747 | 2018-08-08 |
1093231201 | Heather Mairi Ybarra | Behavior Technician | 4216 Wyman Way, Roseville, CA 95747 | 2017-08-18 |
1881114650 | Bridget Bell | Behavior Technician | 8202 Tail Race Dr, Roseville, CA 95747 | 2017-06-22 |
1760911192 | Laura Marie Hummel | Massage Therapist | 9077 Foothills Blvd. Suite 200, Roseville, CA 95747 | 2017-06-08 |
1184975625 | Whitney Anne Wright | Marriage & Family Therapist | 7517 Locomotive Ln, Roseville, CA 95747 | 2012-09-24 |
1962764290 | Panumas Soukaroon | Physical Medicine & Rehabilitation | Glenwood Springs Way, Roseville, CA 95747 | 2012-06-12 |
1134487366 | Tatyana Serikov | Dental Hygienist | 616 Treviso Ct, Roseville, CA 95747 | 2012-04-25 |
1720352099 | Peggy Holcomb | Clinical Neuropsychologist | 4010 Foothills Bvld., Ste. 103-3, Roseville, CA 95747 | 2012-03-02 |
1740577220 | Laina Marie Haider | Occupational Therapist | 7950 Footthills Blvd, The Bridges At Woodcreek Oaks, Roseville, CA 95747 | 2011-07-05 |
Find all providers in zip 95747 |
Taxonomy Code | 101YA0400X |
Grouping | Behavioral Health & Social Service Providers |
Classification | Counselor |
Specialization | Addiction (Substance Use Disorder) |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1013575364 | William Henry Hoffman IIi | Counselor | 2467 Sheldon St, Roseville, MN 55113-3138 | 2019-06-02 |
1962987560 | Bradley Thomas Conley | Counselor | 2233 Hamline Ave N Ste 110, Roseville, MN 55113-5002 | 2018-09-28 |
1386156065 | Gina M Nunez | Counselor | 730 Sunrise Ave Ste 200-201, Roseville, CA 95661-4567 | 2017-11-02 |
1023540515 | Dawn New Awakening LLC | Counselor | 26316 Ronald St, Roseville, MI 48066-4458 | 2017-04-03 |
1700210218 | Ozlem Tekelioglu | Counselor | 1133 Coloma Way Suite C, Roseville, CA 95661 | 2013-09-03 |
1114369816 | Amanda Macmillan | Counselor | 101 Cirby Hills Drive, Roseville, CA 95678 | 2013-07-23 |
1316295082 | Pes-ebs.inc. | Counselor | 340 Lincoln St, Roseville, CA 95678-2230 | 2012-08-28 |
1871860890 | Raymond Richard Evans | Counselor | 2499 Rice Street, Roseville, MN 55113 | 2011-11-18 |
1023308079 | Jennica Rachel Jenkins | Counselor | 1899 E Roseville Pkwy Ste 140, Roseville, CA 95661-7980 | 2011-04-12 |
1154628857 | Kelly Elizabeth Steinbach | Counselor | 1050 Opportunity Dr Ste 160b, Roseville, CA 95678-3030 | 2011-02-16 |
Find all providers in ROSEVILLE |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.