Healthcare Provider Details

I. General information

NPI: 1932138245
Provider Name (Legal Business Name): TAMMY M GROSZCZYK M.S. LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 11/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 ELM GROVE RD STE 6
ELM GROVE WI
53122
US

IV. Provider business mailing address

PO BOX 542
PEWAUKEE WI
53072-0542
US

V. Phone/Fax

Practice location:
  • Phone: 262-695-9061
  • Fax:
Mailing address:
  • Phone: 262-695-9061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3213125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: