Provider Demographics
NPI:1699138354
Name:PATRISIO, GRETCHEN (CSW)
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:
Last Name:PATRISIO
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:GRETCHEN
Other - Middle Name:
Other - Last Name:EASTERBROOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25 KESSEL CT
Mailing Address - Street 2:STE 105
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-6227
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1320 MENDOTA ST
Practice Address - Street 2:STE 120
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53714-1096
Practice Address - Country:US
Practice Address - Phone:608-280-3106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-31
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11914 - 120104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker