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NPI Code Detail

MEDICARE: GRETCHEN M MALKOWSKY CAPSW

MEDICARE: GRETCHEN M MALKOWSKY CAPSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor126659-121WI

General Provider Information

NPI Number : 1841599859
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRETCHEN M MALKOWSKY CAPSW
Provider Business Mailing Address
First Line : PO BOX 588
Second Line :
City : GREEN LAKE
State : WI
Zip : 54941-0588
Country : US
Telephone Number : 920-294-4070
Fax Number : 920-294-4139
Provider Business Practice Location Address
First Line : 571 COUNTY ROAD A
Second Line :
City : GREEN LAKE
State : WI
Zip : 54941-8630
Country : US
Telephone Number : 920-294-4070
Fax Number : 920-294-4139
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/17/2011
Last Update Date : 03/17/2011

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Directions to “ GRETCHEN M MALKOWSKY CAPSW” Practice Location

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