Provider Demographics
NPI:1386975100
Name:GILL, GRETCHEN J (PHD)
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:J
Last Name:GILL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5891 FULHAM CT
Mailing Address - Street 2:
Mailing Address - City:GREENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53129-2133
Mailing Address - Country:US
Mailing Address - Phone:414-793-8273
Mailing Address - Fax:414-855-0402
Practice Address - Street 1:6310 N PORT WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53217-4300
Practice Address - Country:US
Practice Address - Phone:414-961-1600
Practice Address - Fax:414-961-1616
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-18
Last Update Date:2010-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor