Healthcare Provider Details

I. General information

NPI: 1154570638
Provider Name (Legal Business Name): GRETCHEN RACHELLE SACKMANN AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2008
Last Update Date: 09/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 W WISCONSIN AVE STE B340
MILWAUKEE WI
53226-4874
US

IV. Provider business mailing address

9000 W WISCONSIN AVE # MS 958
MILWAUKEE WI
53226-4874
US

V. Phone/Fax

Practice location:
  • Phone: 414-266-2934
  • Fax:
Mailing address:
  • Phone: 414-266-7615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number530-156
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: