Individual
MICHAEL RICHARD GISSIBL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SAC-IT
Contact information
Practice address
2607 N GRANDVIEW BLVD, SUITE 110, WAUKESHA, WI 53188-1686
(262) 313-8339
Mailing address
2607 N GRANDVIEW BLVD, SUITE 110, WAUKESHA, WI 53188-1686
(414) 841-9165
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
03/21/2017
Last updated
03/21/2017
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