Individual
SHELLY A GALLENBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
1225 LANGLADE RD, ANTIGO, WI 54409-2762
(715) 627-6694
(715) 627-6645
Mailing address
1100 LAKE VIEW DR, WAUSAU, WI 54403-6785
(715) 848-4600
(715) 845-5398
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
4293-125
WI
103T00000X
Psychologist
Primary
3111
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3111
STATE LICENSE
WI
01
—
4293-125
STATE LICENSE
WI
Enumeration date
04/01/2010
Last updated
02/03/2014
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