| Doctor Name: | GARY GENE GROTE |
| NPI Number: | 1457493280 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | CSAC |
| License Number: | 15180 |
| Business Practice Address: | 121 Skelley St Schofield, WI - 544761076 |
| Business Phone Number: | 7153550671 |
| Business Fax Number: | 7153550667 |
| Mailing Address: | 1622 N 2nd Ave, WAUSAU |
| State: | WI |
| Postal Code: | 544012522 |
| Phone Number: | 7156759627 |
| Fax Number: | 7153550667 |
| NPI Enumeration Date: | 02/12/2007 |
| NPI Last Update Date: | 06/27/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 15180 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |