Provider Demographics
NPI:1427599786
Name:GENNERMAN-SCHROEDER, REBECCA (MA, LMFT, LPC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:GENNERMAN-SCHROEDER
Suffix:
Gender:F
Credentials:MA, LMFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6502 GRAND TETON PLZ STE 102
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-1047
Mailing Address - Country:US
Mailing Address - Phone:608-827-7220
Mailing Address - Fax:
Practice Address - Street 1:6502 GRAND TETON PLZ STE 102
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1047
Practice Address - Country:US
Practice Address - Phone:608-827-7220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-19
Last Update Date:2017-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5906-125101YP2500X
WI1035-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist