Provider Demographics
NPI:1982220596
Name:WEDGE, GABRIELA (MA)
Entity type:Individual
Prefix:
First Name:GABRIELA
Middle Name:
Last Name:WEDGE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12501 WORLD PLAZA LN BLDG 51
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-3991
Mailing Address - Country:US
Mailing Address - Phone:239-439-3139
Mailing Address - Fax:239-984-4372
Practice Address - Street 1:12501 WORLD PLAZA LN BLDG 51
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-3991
Practice Address - Country:US
Practice Address - Phone:239-439-3139
Practice Address - Fax:239-984-4372
Is Sole Proprietor?:No
Enumeration Date:2020-06-19
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-24-75645103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst