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General NPI Number Information
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NPI Number | 1639068612
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Entity Type | Individual
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Provider Name | GRETCHEN ELIZABETH WOOD LPC-IT ATR-P
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Gender | Female
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Dates
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Enumeration Date | 07/02/2025
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Last Update Date | 07/03/2025
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Provider Practice Location Address
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Address Line | 1309 S ONEIDA ST
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City | APPLETON
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State | WI
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Zip | 54915-1351
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Country | US
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Telephone | 920-903-8841
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Fax |
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Provider Business Mailing Address
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Address Line | 215 N MASON ST
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City | APPLETON
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State | WI
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Zip | 54914-5256
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Country | US
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Telephone | 920-257-4051
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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 | 8573-226
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License Number State | WI
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