Provider Demographics
NPI:1285920736
Name:GUSZKOWSKI, TED CHRISTOPHER (LCSW, SAC)
Entity type:Individual
Prefix:MR
First Name:TED
Middle Name:CHRISTOPHER
Last Name:GUSZKOWSKI
Suffix:
Gender:M
Credentials:LCSW, SAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2003
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-2003
Mailing Address - Country:US
Mailing Address - Phone:262-335-4557
Mailing Address - Fax:
Practice Address - Street 1:333 E WASHINGTON ST STE 2100
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-2503
Practice Address - Country:US
Practice Address - Phone:262-335-4557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15745-131101YA0400X
WI16030-130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1285920736Medicaid