Provider Demographics
NPI:1346977758
Name:GWINNUP, ABBEY LYNN (LCSW)
Entity type:Individual
Prefix:
First Name:ABBEY
Middle Name:LYNN
Last Name:GWINNUP
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ABBEY
Other - Middle Name:LYNN
Other - Last Name:SCHEMEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6601 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53143-4613
Mailing Address - Country:US
Mailing Address - Phone:262-994-0920
Mailing Address - Fax:
Practice Address - Street 1:601 LAKE AVE STE 101C
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53403-1249
Practice Address - Country:US
Practice Address - Phone:262-994-0920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-05
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI99761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical