Provider Demographics
NPI:1619503232
Name:GROCHOWSKI, MATTHEW (LPC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:GROCHOWSKI
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 N MAYFAIR RD STE 650
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-1322
Mailing Address - Country:US
Mailing Address - Phone:414-771-9304
Mailing Address - Fax:
Practice Address - Street 1:2600 N MAYFAIR RD STE 650
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-1322
Practice Address - Country:US
Practice Address - Phone:414-771-9304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-15
Last Update Date:2020-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7666-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional