Deborah Hannah Gault, LICSW

Key facts

NPI

1083464804

Entity type

Individual (NPI type 1)

Primary specialty

Clinical Social Worker 1041C0700X

License

28045 (MN)

Practice address

150 10TH St NW Ste 2
Milaca, MN 56353-1737

Phone

(320) 983-2335

NPI assigned

Mar 25, 2024

Sex

Female

Sole proprietor

No

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lighthouse Child & Family Services Community/Behavioral Health Agency · Foley, MN · NPI 1689861197
  Medicare reassignment NPD MN
• Awakened Connections Therapy Clinical Social Worker · Milaca, MN · NPI 1205632346
  NPD (past) CLINICAL

Medicare participation

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

State licenses

Practice roles

Locations

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 25, 2024.

{
    "created_epoch": "1711324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711324800000",
    "number": "1083464804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 10TH ST NW STE 2",
            "city": "MILACA",
            "state": "MN",
            "postal_code": "563531737",
            "telephone_number": "320-983-2335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 10TH ST NW STE 2",
            "city": "MILACA",
            "state": "MN",
            "postal_code": "563531737",
            "telephone_number": "320-983-2335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAULT",
        "first_name": "DEBORAH",
        "middle_name": "HANNAH",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-03-25",
        "last_updated": "2024-03-25",
        "certification_date": "2024-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "28045",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Kristin French
• George B Gerstenkorn, MD
• Elisabeth Ann Gliddon, LMFT
• Jennifer Jean Goerger, LICSW
• Kelsey Ann Gruba, LMFT
• Raeann Hagen, LICSW

All providers in Milaca, MN · Clinical Social Worker in Minnesota