Healthcare Provider Details

I. General information

NPI: 1962971978
Provider Name (Legal Business Name): GRETCHEN J WATSON MSW MFTIT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2018
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 W HIGHLAND BLVD
MILWAUKEE WI
53208-3252
US

IV. Provider business mailing address

4811 S 76TH ST STE 305
MILWAUKEE WI
53220-4364
US

V. Phone/Fax

Practice location:
  • Phone: 262-444-8050
  • Fax:
Mailing address:
  • Phone: 414-325-7741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number659-228
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1397-124
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: