Basic Information
Provider Information
NPI: 1003145384
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BIALK
FirstName: GAIL
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: LCSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: YAUNKE
OtherFirstName: GAIL
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 700 8TH AVE W
Address2: SUITE 101
City: PALMETTO
State: FL
PostalCode: 342214737
CountryCode: US
TelephoneNumber: 9417764000
FaxNumber: 9418454963
Practice Location
Address1: 12271 US HIGHWAY 301 N
Address2:  
City: PARRISH
State: FL
PostalCode: 342198410
CountryCode: US
TelephoneNumber: 9417764000
FaxNumber:  
Other Information
ProviderEnumerationDate: 12/15/2009
LastUpdateDate: 11/28/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700XSW13749FLY Behavioral Health & Social Service ProvidersSocial WorkerClinical
171M00000X127934-121WIN Other Service ProvidersCase Manager/Care Coordinator 

No ID Information.


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