Provider Demographics
NPI:1326119926
Name:REHKEMPER, GINA MARIE (PHD)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:MARIE
Last Name:REHKEMPER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 W FOREST HOME AVE STE 501
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-2843
Mailing Address - Country:US
Mailing Address - Phone:262-369-7040
Mailing Address - Fax:262-544-1213
Practice Address - Street 1:600 WALNUT RIDGE DR
Practice Address - Street 2:
Practice Address - City:HARTLAND
Practice Address - State:WI
Practice Address - Zip Code:53029-9385
Practice Address - Country:US
Practice Address - Phone:262-369-7040
Practice Address - Fax:262-544-1213
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2106-057103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39123500Medicaid
WI39123500Medicaid
WI847670016Medicare ID - Type Unspecified