Healthcare Provider Details

I. General information

NPI: 1376015701
Provider Name (Legal Business Name): CRAIG A GROSKREUTZ MS, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/25/2018
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E WASHINGTON ST
WEST BEND WI
53095-2571
US

IV. Provider business mailing address

104A FENCE LINE AVE
IRON RIDGE WI
53035
US

V. Phone/Fax

Practice location:
  • Phone: 262-338-2717
  • Fax: 262-338-9767
Mailing address:
  • Phone: 608-317-5544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7205-125
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number5429-57
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: