=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013728153
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LISA GRASSHOFF LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/17/2025
-----------------------------------------------------
Last Update Date | 01/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 222 CHRISTY ST
-----------------------------------------------------
City | AMHERST
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54406-9390
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-574-0671
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1699 SCHOFIELD AVE STE 119120
-----------------------------------------------------
City | SCHOFIELD
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54476-2338
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-574-0671
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 8265226
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------