Healthcare Provider Details

I. General information

NPI: 1235124173
Provider Name (Legal Business Name): ROXANNE MARIE GUENTHER LCSW, SASA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 02/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12970 W BLUEMOUND RD SUITE 308
ELM GROVE WI
53122-2607
US

IV. Provider business mailing address

12970 W BLUEMOUND RD STE 200
ELM GROVE WI
53122-2607
US

V. Phone/Fax

Practice location:
  • Phone: 262-780-1020
  • Fax: 262-780-1022
Mailing address:
  • Phone: 262-780-1020
  • Fax: 262-780-1022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number13082
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7037-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: