Provider Demographics
NPI:1215432687
Name:GROBOSKI, CYNTHIA A (LPC)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:A
Last Name:GROBOSKI
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 S. WALNUT ST.
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-5918
Mailing Address - Country:US
Mailing Address - Phone:920-832-5270
Mailing Address - Fax:920-832-5488
Practice Address - Street 1:320 S. WALNUT ST.
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-5918
Practice Address - Country:US
Practice Address - Phone:920-832-5270
Practice Address - Fax:920-832-5488
Is Sole Proprietor?:No
Enumeration Date:2018-03-28
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6416125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional