Healthcare Provider Details

I. General information

NPI: 1346977758
Provider Name (Legal Business Name): ABBEY LYNN GWINNUP LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ABBEY LYNN SCHEMEL

II. Dates (important events)

Enumeration Date: 08/05/2022
Last Update Date: 11/29/2022
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 LAKE AVE STE 101C
RACINE WI
53403-1249
US

IV. Provider business mailing address

6601 28TH AVE
KENOSHA WI
53143-4613
US

V. Phone/Fax

Practice location:
  • Phone: 262-994-0920
  • Fax:
Mailing address:
  • Phone: 262-994-0920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9976
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: