| Doctor Name: | MR. JAY WILLIAM GAETHKE |
| NPI Number: | 1346325446 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LPC, SAC, CSW |
| License Number: | |
| Business Practice Address: | 500 Elm Grove Rd Suite 100 Elm Grove, WI - 531222546 |
| Business Phone Number: | 2627822090 |
| Business Fax Number: | 2627822092 |
| Mailing Address: | 500 Elm Grove Rd, Suite 100 ELM GROVE |
| State: | WI |
| Postal Code: | 531222546 |
| Phone Number: | 2627822090 |
| Fax Number: | 2627822092 |
| NPI Enumeration Date: | 10/26/2006 |
| NPI Last Update Date: | 08/30/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |