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NPI Code Detail

MEDICARE: LISA GUTZKE LPC

MEDICARE: LISA GUTZKE LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor20322-130WI
2101YP2500XProfessional Counselor4455-125WI
3101YM0800XMental Health Counselor4455-125WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1083916217
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA GUTZKE LPC
Provider Business Mailing Address
First Line : 251 PROGRESS WAY STE 102
Second Line :
City : WAUNAKEE
State : WI
Zip : 53597-2520
Country : US
Telephone Number : 608-849-5430
Fax Number : 858-225-7950
Provider Business Practice Location Address
First Line : 251 PROGRESS WAY STE 102
Second Line :
City : WAUNAKEE
State : WI
Zip : 53597-2520
Country : US
Telephone Number : 608-849-5430
Fax Number : 858-225-7950
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/19/2010
Last Update Date : 02/10/2024

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