Individual
PATRICIA GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1225 LANGLADE ROAD, ANTIGO, WI 54409
(715) 623-2394
(715) 627-4194
Mailing address
1100 LAKE VIEW DRIVE, WAUSAU, WI 54403
(715) 848-4600
(715) 845-5398
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
554-125
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39631000
—
WI
Enumeration date
10/04/2006
Last updated
07/08/2007
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