Provider Demographics
NPI:1558914085
Name:GUMZ, PATRICIA KAREN (APSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:KAREN
Last Name:GUMZ
Suffix:
Gender:F
Credentials:APSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 N. 1ST ST, SUITE 5000
Mailing Address - Street 2:OPTIONAL
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54403-4727
Mailing Address - Country:US
Mailing Address - Phone:715-675-3458
Mailing Address - Fax:715-675-7238
Practice Address - Street 1:731 N. 1ST ST, SUITE 5000
Practice Address - Street 2:OPTIONAL
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-4727
Practice Address - Country:US
Practice Address - Phone:715-675-3458
Practice Address - Fax:715-675-7238
Is Sole Proprietor?:No
Enumeration Date:2019-07-23
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19066-130101YA0400X
WI129061104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI129061OtherAPSW LICENSE