Provider Demographics
NPI:1184669723
Name:SPIEGEL, GRETCHEN F (MS LCSW)
Entity Type:Individual
Prefix:MS
First Name:GRETCHEN
Middle Name:F
Last Name:SPIEGEL
Suffix:
Gender:F
Credentials:MS LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:DODGEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53533-1176
Mailing Address - Country:US
Mailing Address - Phone:608-935-2838
Mailing Address - Fax:608-935-9227
Practice Address - Street 1:9 ODANA CT
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719
Practice Address - Country:US
Practice Address - Phone:608-274-5181
Practice Address - Fax:608-274-5181
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI26851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39520400Medicaid
WI000344580Medicare ID - Type Unspecified
WI000384970Medicare ID - Type Unspecified