Provider Demographics
NPI:1376015701
Name:GROSKREUTZ, CRAIG A (MS, LPC)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:A
Last Name:GROSKREUTZ
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104A FENCE LINE AVE
Mailing Address - Street 2:
Mailing Address - City:IRON RIDGE
Mailing Address - State:WI
Mailing Address - Zip Code:53035
Mailing Address - Country:US
Mailing Address - Phone:608-317-5544
Mailing Address - Fax:
Practice Address - Street 1:111 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-2571
Practice Address - Country:US
Practice Address - Phone:262-338-2717
Practice Address - Fax:262-338-9767
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-25
Last Update Date:2018-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional