Provider Demographics
NPI:1487847737
Name:GULCZYNSKI, DENNIS F (PHD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:F
Last Name:GULCZYNSKI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 BREWSTER DR
Mailing Address - Street 2:
Mailing Address - City:LAKE MILLS
Mailing Address - State:WI
Mailing Address - Zip Code:53551-1702
Mailing Address - Country:US
Mailing Address - Phone:920-222-6500
Mailing Address - Fax:920-648-5625
Practice Address - Street 1:231 WOODLAND BEACH RD
Practice Address - Street 2:
Practice Address - City:LAKE MILLS
Practice Address - State:WI
Practice Address - Zip Code:53551-1855
Practice Address - Country:US
Practice Address - Phone:920-222-6500
Practice Address - Fax:920-648-5625
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3656-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional