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General NPI Number Information
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NPI Number | 1598540817
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Entity Type | Individual
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Provider Name | BROOKE MARIE GARDINER-SMITH MS, LPC-IT
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Gender | Female
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Dates
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Enumeration Date | 08/25/2023
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Last Update Date | 01/29/2025
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Provider Practice Location Address
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Address Line | 5944 SEMINOLE CENTER CTE. SUITE 210
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City | FITCHBURG
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State | WI
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Zip | 53711
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Country | US
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Telephone | 844-467-3467
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Fax | 608-221-0885
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Provider Business Mailing Address
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Address Line | 1775 LINNERUD DR APT 218
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City | SUN PRAIRIE
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State | WI
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Zip | 53590-3615
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Country | US
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Telephone | 608-778-7430
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 7568-226
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License Number State | WI
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