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General NPI Number Information
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NPI Number | 1376015701
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Entity Type | Individual
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Provider Name | CRAIG A GROSKREUTZ MS, LPC
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Gender | Male
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Dates
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Enumeration Date | 12/25/2018
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Last Update Date | 09/09/2025
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Provider Practice Location Address
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Address Line | 111 E WASHINGTON ST
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City | WEST BEND
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State | WI
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Zip | 53095-2571
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Country | US
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Telephone | 262-338-2717
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Fax | 262-338-9767
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Provider Business Mailing Address
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Address Line | 104A FENCE LINE AVE
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City | IRON RIDGE
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State | WI
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Zip | 53035
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Country | US
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Telephone | 608-317-5544
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 7205-125
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 5429-57
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License Number State | WI
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