MEDICARE: MS. ANDREA MARIE GREUBEL SAC-IT

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	19832-130	WI

General Provider Information

NPI Number	:	1417732462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANDREA MARIE GREUBEL SAC-IT

Provider Business Mailing Address
First Line	:	211 15TH ST S
Second Line	:
City	:	WISCONSIN RAPIDS
State	:	WI
Zip	:	54494-4602
Country	:	US
Telephone Number	:	608-228-4702
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 ILLINOIS AVE
Second Line	:
City	:	STEVENS POINT
State	:	WI
Zip	:	54481-1943
Country	:	US
Telephone Number	:	715-346-5087
Fax Number	:	715-346-5645

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

Provider Enumeration Date	:	08/29/2023
Last Update Date	:	08/29/2023

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