| Doctor Name: | PATRICIA GUSTAFSON |
| NPI Number: | 1245326891 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 554-125 |
| Business Practice Address: | 1225 Langlade Road Antigo, WI - 54409 |
| Business Phone Number: | 7156232394 |
| Business Fax Number: | 7156274194 |
| Mailing Address: | 1100 Lake View Drive, WAUSAU |
| State: | WI |
| Postal Code: | 54403 |
| Phone Number: | 7158484600 |
| Fax Number: | 7158455398 |
| NPI Enumeration Date: | 10/04/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 554-125 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |