Provider Demographics
NPI:1669202263
Name:GUENTHER, BROOKE L
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:L
Last Name:GUENTHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 BARBERRY DR STE 110
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53545-0589
Mailing Address - Country:US
Mailing Address - Phone:608-758-1944
Mailing Address - Fax:608-758-1960
Practice Address - Street 1:1312 BARBERRY DR STE 110
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-0589
Practice Address - Country:US
Practice Address - Phone:608-758-1944
Practice Address - Fax:608-758-1960
Is Sole Proprietor?:No
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20562-130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)