Healthcare Provider Details

I. General information

NPI: 1356263180
Provider Name (Legal Business Name): CARIESA BARBARA ANN GROSS MA, LPC-IT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2831 POST RD STE 300
PLOVER WI
54467-3415
US

IV. Provider business mailing address

680 EVANS ST
WAUPACA WI
54981-2039
US

V. Phone/Fax

Practice location:
  • Phone: 715-600-2798
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number9218-226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: