Provider Demographics
NPI:1124465620
Name:BREWER, GREGG ROBERT (MS)
Entity type:Individual
Prefix:MR
First Name:GREGG
Middle Name:ROBERT
Last Name:BREWER
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 N WESTHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54904-6947
Mailing Address - Country:US
Mailing Address - Phone:920-456-2030
Mailing Address - Fax:920-456-2025
Practice Address - Street 1:700 N WESTHAVEN DR
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54904-6947
Practice Address - Country:US
Practice Address - Phone:920-456-2030
Practice Address - Fax:920-456-2025
Is Sole Proprietor?:No
Enumeration Date:2013-05-24
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI610-125101YM0800X
WI1071-1231041C0700X
WI87-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist