Provider Demographics
NPI:1629304597
Name:GRETEBECK, RACHEL J (MS, CSAC)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:J
Last Name:GRETEBECK
Suffix:
Gender:F
Credentials:MS, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 387
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53082-0387
Mailing Address - Country:US
Mailing Address - Phone:920-458-5557
Mailing Address - Fax:920-458-2692
Practice Address - Street 1:3425 SUPERIOR AVE
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-1863
Practice Address - Country:US
Practice Address - Phone:920-458-5557
Practice Address - Fax:920-458-2692
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-27
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13997-132101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health