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General NPI Number Information
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NPI Number | 1831471572
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Entity Type | Individual
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Provider Name | AMY LYNN GRESKIW LCPC
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Gender | Female
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Dates
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Enumeration Date | 09/19/2011
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Last Update Date | 12/20/2024
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Provider Practice Location Address
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Address Line | 8600 75TH ST
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City | KENOSHA
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State | WI
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Zip | 53142-8200
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Country | US
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Telephone | 262-652-9433
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Fax |
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Provider Business Mailing Address
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Address Line | 8724 246TH CT
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City | SALEM
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State | WI
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Zip | 53168-9092
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Country | US
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Telephone | 847-377-8950
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 11011-125
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180006183
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License Number State | IL
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