Provider Demographics
NPI:1801907498
Name:SEITZ, GERALD ANDREW (RADCI)
Entity type:Individual
Prefix:MR
First Name:GERALD
Middle Name:ANDREW
Last Name:SEITZ
Suffix:
Gender:M
Credentials:RADCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1635 MAPLE LN
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54806-3610
Mailing Address - Country:US
Mailing Address - Phone:715-685-5400
Mailing Address - Fax:715-685-5102
Practice Address - Street 1:1635 MAPLE LN
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:WI
Practice Address - Zip Code:54806-3610
Practice Address - Country:US
Practice Address - Phone:715-685-5400
Practice Address - Fax:715-685-5102
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15565-131101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1801907498Medicaid