Provider Demographics
NPI:1164458626
Name:GJESTSON, LAURA JEAN (LCSW LICENSED CLINCI)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:JEAN
Last Name:GJESTSON
Suffix:
Gender:F
Credentials:LCSW LICENSED CLINCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:829 S IOWA ST
Mailing Address - Street 2:UPLANDS COUNSELING ASSOCIATES
Mailing Address - City:DODGEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53533
Mailing Address - Country:US
Mailing Address - Phone:608-935-2838
Mailing Address - Fax:608-935-9227
Practice Address - Street 1:829 S IOWA ST
Practice Address - Street 2:
Practice Address - City:DODGEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53533
Practice Address - Country:US
Practice Address - Phone:608-935-2838
Practice Address - Fax:608-935-9227
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WILCSW6801123101YM0800X, 1041C0700X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist