Individual
MS. GRETCHEN FAIRWEATHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CAPSW
Contact information
Practice address
1801 DOLPHIN DR, WAUKESHA, WI 53186-1430
(262) 953-8550
Mailing address
1801 DOLPHIN DR, WAUKESHA, WI 53186-1430
(262) 953-8550
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
127899-121
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
127899-121
SOCIAL WORK CERTIFICATION
WI
Enumeration date
08/20/2012
Last updated
08/20/2012
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