Basic Information
| Provider Information | |||||||||
| NPI: | 1114644333 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SUCHY | ||||||||
| FirstName: | GAIL | ||||||||
| MiddleName: | |||||||||
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| Credential: | CPSS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 66558 | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708966558 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2259222700 | ||||||||
| FaxNumber: | 2253625319 | ||||||||
| Practice Location | |||||||||
| Address1: | 2751 WOODDALE BLVD STE A | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708057567 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2259251906 | ||||||||
| FaxNumber: | 2253625356 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2022 | ||||||||
| LastUpdateDate: | 11/10/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 175T00000X | Y |
No ID Information.