Healthcare Provider Details

I. General information

NPI: 1821245192
Provider Name (Legal Business Name): ERIC C GEBHART B.S., CSAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2008
Last Update Date: 10/01/2020
Certification Date: 10/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1307 STATE ROAD 69
NEW GLARUS WI
53574-9328
US

IV. Provider business mailing address

1307 STATE ROAD 69
NEW GLARUS WI
53574-9328
US

V. Phone/Fax

Practice location:
  • Phone: 608-527-2426
  • Fax: 608-527-1939
Mailing address:
  • Phone: 608-527-2426
  • Fax: 608-527-1939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number15274-132
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: