Healthcare Provider Details

I. General information

NPI: 1841358827
Provider Name (Legal Business Name): CELIA J GARDNER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CELIA J RODRIGUEZ LPC

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 RIVERSIDE DR
GREEN BAY WI
54301-1900
US

IV. Provider business mailing address

2300 RIVERSIDE DR
GREEN BAY WI
54301-1900
US

V. Phone/Fax

Practice location:
  • Phone: 920-393-7995
  • Fax:
Mailing address:
  • Phone: 920-393-7995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4304-125
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number61185
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: