Individual
PATRICIA ROSE GUTIERREZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CSAC, ICS, LPC
Contact information
Practice address
147 RANDALL ST, WAUKESHA, WI 53188-3528
(262) 510-8490
Mailing address
147 RANDALL ST, WAUKESHA, WI 53188-3528
(262) 510-8490
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
11046
WI
101YA0400X
Addiction (Substance Use Disorder) Counselor
11046-132
WI
101YM0800X
Mental Health Counselor
Primary
7295-125
WI
101YP2500X
Professional Counselor
7295-125
—
101YP2500X
Professional Counselor
—
WI
101YP2500X
Professional Counselor
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1952577488
—
WI
05
—
39384900
—
WI
Enumeration date
05/05/2008
Last updated
10/14/2020
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