Individual
LAURENCE GANSCHOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CADC III
Contact information
Practice address
8200 W BROWN DEER RD, SUITE 300A, BROWN DEER, WI 53223-1706
(414) 362-8147
(414) 362-7198
Mailing address
285 N JANACEK RD, BROOKFIELD, WI 53045-6102
(262) 641-9050
(262) 641-9126
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1736-132
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39370500
—
WI
Enumeration date
01/25/2007
Last updated
07/10/2008
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