Healthcare Provider Details

I. General information

NPI: 1447635701
Provider Name (Legal Business Name): JANEL GASSNER MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2015
Last Update Date: 12/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2266 N PROSPECT AVE STE 326
MILWAUKEE WI
53202-6323
US

IV. Provider business mailing address

2266 N PROSPECT AVE STE 326
MILWAUKEE WI
53202-6323
US

V. Phone/Fax

Practice location:
  • Phone: 414-224-0492
  • Fax: 414-224-8112
Mailing address:
  • Phone: 414-224-0492
  • Fax: 414-224-8112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number17283
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number101YA0400X
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: