Provider Demographics
NPI:1912636895
Name:HESSE, GABRIELLE (CAPSW)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:
Last Name:HESSE
Suffix:
Gender:F
Credentials:CAPSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 S PATERSON ST STE 1A
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-4534
Mailing Address - Country:US
Mailing Address - Phone:608-571-0558
Mailing Address - Fax:608-807-5675
Practice Address - Street 1:303 S PATERSON ST STE 1A
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-4534
Practice Address - Country:US
Practice Address - Phone:608-571-0558
Practice Address - Fax:608-807-5675
Is Sole Proprietor?:No
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1323241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI132324-121OtherWI DEPARTMENT OF SAFETY & PROFESSIONAL SERVICES