| Doctor Name: | MRS. GRETCHEN ANNE EBELT |
| NPI Number: | 1265765564 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSW |
| License Number: | 1763-121 |
| Business Practice Address: | 1325 Angels Path De Pere, WI - 541154050 |
| Business Phone Number: | 9203382855 |
| Business Fax Number: | 9204037360 |
| Mailing Address: | Po Box 22040, GREEN BAY |
| State: | WI |
| Postal Code: | 543052040 |
| Phone Number: | 9204457222 |
| Fax Number: | 9204457289 |
| NPI Enumeration Date: | 09/17/2009 |
| NPI Last Update Date: | 04/13/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 1763-121 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |