Individual
GLORIA LYNN FENNELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1099 S SHORE RD, LA POINTE, WI 54850-4516
(715) 456-9369
Mailing address
PO BOX 162, LA POINTE, WI 54850-0162
(715) 456-9369
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1203-123
WI
Other
Enumeration date
04/12/2021
Last updated
04/12/2021
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