Provider Demographics
NPI:1194830414
Name:GAERTNER, KEITH ROBERT (MS, LPC)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:ROBERT
Last Name:GAERTNER
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11104 W GREENFIELD AVE
Mailing Address - Street 2:#12
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53214-2380
Mailing Address - Country:US
Mailing Address - Phone:414-526-9784
Mailing Address - Fax:414-536-8348
Practice Address - Street 1:3800 N MAYFAIR RD
Practice Address - Street 2:LUTHERAN COUNSELING AND FAMILY SERVICES
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53222-2213
Practice Address - Country:US
Practice Address - Phone:414-536-8333
Practice Address - Fax:414-536-8348
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3508-125101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40987100Medicaid