=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477543981
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PATRICIA GLATZEL CLOUGH MS, ATR, LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/26/2005
-----------------------------------------------------
Last Update Date | 11/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 203 E WISCONSIN AVE STE 302
-----------------------------------------------------
City | OCONOMOWOC
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53066-3141
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-429-6403
-----------------------------------------------------
Fax | 262-354-0971
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1085 REVERE DR
-----------------------------------------------------
City | OCONOMOWOC
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53066-4422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-429-6403
-----------------------------------------------------
Fax | 262-354-0839
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 3398-125
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------