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General NPI Number Information
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NPI Number | 1639404056
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Entity Type | Individual
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Provider Name | LISA ANN GREGORIUS M.A.
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Gender | Female
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Dates
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Enumeration Date | 10/03/2009
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Last Update Date | 10/03/2009
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Provider Practice Location Address
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Address Line | 3900 W BROWN DEER RD SUITE 200
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City | BROWN DEER
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State | WI
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Zip | 53209-1220
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Country | US
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Telephone | 262-306-7335
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Fax |
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Provider Business Mailing Address
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Address Line | 1140 N GLENWOOD CIR
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City | WEST BEND
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State | WI
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Zip | 53090-1774
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Country | US
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Telephone | 262-306-7335
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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 | 106-226
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License Number State | WI
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