Doctor Name: | JENNIFER RAE GOZDZIALSKI |
NPI Number: | 1548605728 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.A.C. |
License Number: | 1681-226 |
Business Practice Address: | 810 Lincoln St Kewaunee, WI - 542161140 |
Business Phone Number: | 9203887044 |
Business Fax Number: | 9203887044 |
Mailing Address: | 810 Lincoln St, KEWAUNEE |
State: | WI |
Postal Code: | 542161140 |
Phone Number: | 9203887044 |
Fax Number: | 9203887044 |
NPI Enumeration Date: | 05/01/2013 |
NPI Last Update Date: | 05/01/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 1681-226 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |