Provider Demographics
NPI:1033341953
Name:GISSIBL, SHEILA MARIE (PSYD)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:MARIE
Last Name:GISSIBL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:SHEILA
Other - Middle Name:MARIE
Other - Last Name:KRAWCZYK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:2607 N GRANDVIEW BLVD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-1686
Mailing Address - Country:US
Mailing Address - Phone:262-313-8339
Mailing Address - Fax:262-910-1653
Practice Address - Street 1:2607 N GRANDVIEW BLVD
Practice Address - Street 2:SUITE 108
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-1686
Practice Address - Country:US
Practice Address - Phone:262-313-8339
Practice Address - Fax:262-910-1653
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-11
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2997-57103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1033341953Medicaid