Healthcare Provider Details

I. General information

NPI: 1639068612
Provider Name (Legal Business Name): GRETCHEN ELIZABETH WOOD LPC-IT ATR-P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2025
Last Update Date: 07/03/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 S ONEIDA ST
APPLETON WI
54915-1351
US

IV. Provider business mailing address

215 N MASON ST
APPLETON WI
54914-5256
US

V. Phone/Fax

Practice location:
  • Phone: 920-903-8841
  • Fax:
Mailing address:
  • Phone: 920-257-4051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8573-226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: