Organization
VINCENT A GRASER
Active
Other names
Lakeside Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
VINCENT A GRASER MSSAD (CLINICAL SOCIAL WORKER)
(920) 458-9434
Entity
Organization
Contact information
Practice address
833 PENNSYLVANIA AVE, SUITE 103, SHEBOYGAN, WI 53081-4452
(920) 458-9434
(920) 458-6313
Mailing address
833 PENNSYLVANIA AVE., PO BOX 1143, SHEBOYGAN, WI 53082-1143
(920) 458-9434
(920) 458-6313
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
1501
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42126500
—
WI
Enumeration date
10/25/2006
Last updated
08/22/2020
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