Provider Demographics
NPI:1235124173
Name:GUENTHER, ROXANNE MARIE (LCSW, SASA)
Entity type:Individual
Prefix:MRS
First Name:ROXANNE
Middle Name:MARIE
Last Name:GUENTHER
Suffix:
Gender:F
Credentials:LCSW, SASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12970 W BLUEMOUND RD STE 200
Mailing Address - Street 2:
Mailing Address - City:ELM GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53122-2607
Mailing Address - Country:US
Mailing Address - Phone:262-780-1020
Mailing Address - Fax:262-780-1022
Practice Address - Street 1:12970 W BLUEMOUND RD
Practice Address - Street 2:SUITE 308
Practice Address - City:ELM GROVE
Practice Address - State:WI
Practice Address - Zip Code:53122-2607
Practice Address - Country:US
Practice Address - Phone:262-780-1020
Practice Address - Fax:262-780-1022
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-16
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13082101YA0400X
WI7037-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI13082OtherCADC-D
WI7037-123OtherLCSW
WI40949900Medicaid
WI13082OtherCADC-D