Provider Demographics
NPI:1679989727
Name:LANDSEE, GINA (MSE)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:LANDSEE
Suffix:
Gender:F
Credentials:MSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:561 S ROSA ST
Mailing Address - Street 2:
Mailing Address - City:RICHLAND CENTER
Mailing Address - State:WI
Mailing Address - Zip Code:53581-2641
Mailing Address - Country:US
Mailing Address - Phone:608-604-4052
Mailing Address - Fax:
Practice Address - Street 1:S1597 HANSON RD
Practice Address - Street 2:
Practice Address - City:WESTBY
Practice Address - State:WI
Practice Address - Zip Code:54667-8396
Practice Address - Country:US
Practice Address - Phone:608-574-0582
Practice Address - Fax:608-634-6981
Is Sole Proprietor?:No
Enumeration Date:2014-07-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2186-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional