Individual
GARY GENE GROTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CSAC
Contact information
Practice address
114 GRAND AVE, WAUSAU, WI 54403-6214
(715) 845-7175
(715) 845-7142
Mailing address
114 GRAND AVE, WAUSAU, WI 54403-6214
(715) 845-7175
(715) 845-7142
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
15180
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39174300
—
WI
Enumeration date
02/12/2007
Last updated
11/09/2016
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