Provider Demographics
NPI:1477543981
Name:CLOUGH, PATRICIA GLATZEL (MS, ATR, LPC)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:GLATZEL
Last Name:CLOUGH
Suffix:
Gender:F
Credentials:MS, ATR, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1085 REVERE DR
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-4422
Mailing Address - Country:US
Mailing Address - Phone:414-429-6403
Mailing Address - Fax:262-354-0839
Practice Address - Street 1:418 E WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-3040
Practice Address - Country:US
Practice Address - Phone:414-429-6403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3398125101YP2500X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40961900Medicaid