Individual
MRS. MARY JEAN GONWA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
279 S 17TH AVE, SUITE 10, WEST BEND, WI 53095-3001
(262) 306-9317
Mailing address
111 E WASHINGTON ST, SUITE 200, WEST BEND, WI 53095-2571
(262) 338-2717
(262) 338-9767
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
796
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39708200
—
WI
Enumeration date
08/27/2006
Last updated
10/05/2016
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