Healthcare Provider Details

I. General information

NPI: 1538276720
Provider Name (Legal Business Name): LAURI CHRISTINE GEBHARD PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 07/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15300 WATERTOWN PLANK RD STE 106
ELM GROVE WI
53122-2348
US

IV. Provider business mailing address

15300 WATERTOWN PLANK RD STE 106
ELM GROVE WI
53122-2348
US

V. Phone/Fax

Practice location:
  • Phone: 414-807-8934
  • Fax: 414-302-1330
Mailing address:
  • Phone: 414-807-8934
  • Fax: 414-302-1330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberWI2028
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: