Individual
SAMANTHA GONNERING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5228 W FOND DU LAC AVE, MILWAUKEE, WI 53216-1346
(414) 871-9111
Mailing address
125 E WELLS ST APT FA601, MILWAUKEE, WI 53202-3579
(920) 207-9613
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
17008-130
WI
101YM0800X
Mental Health Counselor
Primary
2235-226
WI
Other
Enumeration date
10/29/2014
Last updated
10/29/2014
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