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NPI Code Detail

MEDICARE: COLLEEN MICHELLE GROMOWSKI MS,LMFT

MEDICARE: COLLEEN MICHELLE GROMOWSKI MS,LMFT
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
1106H00000XMarriage & Family Therapist618-124WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1952475204
Entity Type Code : Individual
Provider Name (Legal Business Name) : COLLEEN MICHELLE GROMOWSKI MS,LMFT
Provider Business Mailing Address
First Line : 201 MAIN ST STE 500
Second Line :
City : LA CROSSE
State : WI
Zip : 54601-0716
Country : US
Telephone Number : 608-668-4005
Fax Number :
Provider Business Practice Location Address
First Line : 130 E WALNUT ST
Second Line : SUITE 706
City : GREEN BAY
State : WI
Zip : 54301-4239
Country : US
Telephone Number : 920-437-8256
Fax Number : 920-437-1188
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/20/2006
Last Update Date : 07/19/2022

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