Healthcare Provider Details

I. General information

NPI: 1629019104
Provider Name (Legal Business Name): PAUL W GASSER MS MFT LCSW CADC III
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 03/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 WATER AVE
HILLSBORO WI
54634-9054
US

IV. Provider business mailing address

400 WATER AVE
HILLSBORO WI
54634-9054
US

V. Phone/Fax

Practice location:
  • Phone: 608-489-8000
  • Fax:
Mailing address:
  • Phone: 608-489-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1125
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1519
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number356
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: