Provider Demographics
NPI:1083916217
Name:GUTZKE, LISA (LPC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:GUTZKE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 PROGRESS WAY STE 102
Mailing Address - Street 2:
Mailing Address - City:WAUNAKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53597-2520
Mailing Address - Country:US
Mailing Address - Phone:608-849-5430
Mailing Address - Fax:858-225-7950
Practice Address - Street 1:251 PROGRESS WAY STE 102
Practice Address - Street 2:
Practice Address - City:WAUNAKEE
Practice Address - State:WI
Practice Address - Zip Code:53597-2520
Practice Address - Country:US
Practice Address - Phone:608-849-5430
Practice Address - Fax:858-225-7950
Is Sole Proprietor?:No
Enumeration Date:2010-11-19
Last Update Date:2024-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20322-130101YA0400X
WI4455-125101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1083961217Medicaid