Healthcare Provider Details

I. General information

NPI: 1184669723
Provider Name (Legal Business Name): GRETCHEN F SPIEGEL MS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 01/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 ODANA CT
MADISON WI
53719
US

IV. Provider business mailing address

1118 PROFESSIONAL DR
DODGEVILLE WI
53533-1176
US

V. Phone/Fax

Practice location:
  • Phone: 608-274-5181
  • Fax: 608-274-5181
Mailing address:
  • Phone: 608-935-2838
  • Fax: 608-935-9227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2685
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: