Healthcare Provider Details

I. General information

NPI: 1194830414
Provider Name (Legal Business Name): KEITH R GAERTNER LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E WISCONSIN AVE STE 1500
MILWAUKEE WI
53202-4808
US

IV. Provider business mailing address

11104 W GREENFIELD AVE #12
WEST ALLIS WI
53214-2380
US

V. Phone/Fax

Practice location:
  • Phone: 262-999-3495
  • Fax: 414-677-7198
Mailing address:
  • Phone: 414-526-9784
  • Fax: 414-536-8348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3508-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: