MEDICARE: GRETCHEN POELLINGER 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
1	101YP2500X	Professional Counselor	11153	WI

General Provider Information

NPI Number	:	1326764366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRETCHEN POELLINGER LPC

Provider Business Mailing Address
First Line	:	704 SAND LAKE RD
Second Line	:
City	:	ONALASKA
State	:	WI
Zip	:	54650-2400
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	704 SAND LAKE RD
Second Line	:
City	:	ONALASKA
State	:	WI
Zip	:	54650-2400
Country	:	US
Telephone Number	:	608-765-8783
Fax Number	:	608-305-8970

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2022
Last Update Date	:	09/23/2024

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