Provider Demographics
NPI:1740365378
Name:VINCENT A GRASER
Entity type:Organization
Organization Name:VINCENT A GRASER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:A
Authorized Official - Last Name:GRASER
Authorized Official - Suffix:
Authorized Official - Credentials:MSSAD
Authorized Official - Phone:920-458-9434
Mailing Address - Street 1:833 PENNSYLVANIA AVE.
Mailing Address - Street 2:PO BOX 1143
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53082-1143
Mailing Address - Country:US
Mailing Address - Phone:920-458-9434
Mailing Address - Fax:920-458-6313
Practice Address - Street 1:833 PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-4452
Practice Address - Country:US
Practice Address - Phone:920-458-9434
Practice Address - Fax:920-458-6313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1501261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42126500Medicaid
WI42126500Medicaid