Individual
GRETCHEN DOMINOWSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC-IT, SAC-IT
Contact information
Practice address
1810 APPLETON RD, MENASHA, WI 54952-1110
(920) 739-4226
(920) 432-5966
Mailing address
PO BOX 22308, GREEN BAY, WI 54305-2308
(920) 436-6800
(920) 432-5966
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
19223
WI
101YM0800X
Mental Health Counselor
Primary
4648-226
WI
Other
Enumeration date
06/24/2020
Last updated
12/18/2020
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