Provider Demographics
NPI:1003052572
Name:GUTIERREZ, JESSICA MARIE (LCSW, CSAC, ICS)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:LCSW, CSAC, ICS
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:MARIE
Other - Last Name:GUTIERREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PANKRATZ
Mailing Address - Street 1:100 RIVER PL STE 260
Mailing Address - Street 2:
Mailing Address - City:MONONA
Mailing Address - State:WI
Mailing Address - Zip Code:53716-4043
Mailing Address - Country:US
Mailing Address - Phone:608-466-6560
Mailing Address - Fax:
Practice Address - Street 1:2101 LINDEN AVE APT 2
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-5350
Practice Address - Country:US
Practice Address - Phone:608-466-6560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-05
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15584-132101YA0400X
WI7533-1231041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)