Individual
GREGORY DEZELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
1190 PRAIRIE ST, PRAIRIE DU SAC, WI 53578-2044
(608) 370-6551
Mailing address
310 N MIDVALE BLVD STE 202, MADISON, WI 53705-3265
(608) 852-8601
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
9553-123
WI
Other
Enumeration date
02/17/2021
Last updated
10/28/2021
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