Provider Demographics
NPI:1871241190
Name:STRASSER, GINA (CAPSW , SAC-IT)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:STRASSER
Suffix:
Gender:F
Credentials:CAPSW , SAC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227400 RIB MOUNTAIN DR STE D
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-5049
Mailing Address - Country:US
Mailing Address - Phone:715-301-0667
Mailing Address - Fax:715-879-2267
Practice Address - Street 1:227400 RIB MOUNTAIN DR STE D
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-5049
Practice Address - Country:US
Practice Address - Phone:715-301-0667
Practice Address - Fax:715-879-2267
Is Sole Proprietor?:No
Enumeration Date:2022-03-15
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI132523-121104100000X
WI11529-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100200158Medicaid