Provider Demographics
NPI:1275787327
Name:KOREN, GABRIELLE GERMAINE (LCSW, SAC)
Entity Type:Individual
Prefix:MISS
First Name:GABRIELLE
Middle Name:GERMAINE
Last Name:KOREN
Suffix:
Gender:F
Credentials:LCSW, SAC
Other - Prefix:
Other - First Name:GABRIELLE
Other - Middle Name:GERMAINE
Other - Last Name:KAUTZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7974 UW HEALTH CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-5531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25 KESSEL CT
Practice Address - Street 2:SUITE 200
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-6227
Practice Address - Country:US
Practice Address - Phone:608-278-8200
Practice Address - Fax:608-278-8204
Is Sole Proprietor?:No
Enumeration Date:2008-11-14
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15582101YA0400X
WI76401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)