Provider Demographics
NPI:1225253610
Name:GREDLER, KAREN ROSE (LMFT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ROSE
Last Name:GREDLER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4513 VERNON BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-4964
Mailing Address - Country:US
Mailing Address - Phone:608-233-2333
Mailing Address - Fax:
Practice Address - Street 1:4513 VERNON BLVD STE 104
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-4964
Practice Address - Country:US
Practice Address - Phone:608-233-2333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI742-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist