Provider Demographics
NPI:1598540817
Name:GARDINER-SMITH, BROOKE MARIE (MS, LPC-IT)
Entity type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:MARIE
Last Name:GARDINER-SMITH
Suffix:
Gender:F
Credentials:MS, LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1775 LINNERUD DR APT 218
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-3615
Mailing Address - Country:US
Mailing Address - Phone:608-778-7430
Mailing Address - Fax:
Practice Address - Street 1:5944 SEMINOLE CENTER CTE.
Practice Address - Street 2:SUITE 210
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53711
Practice Address - Country:US
Practice Address - Phone:844-467-3467
Practice Address - Fax:608-221-0885
Is Sole Proprietor?:No
Enumeration Date:2023-08-25
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7568-226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health