Provider Demographics
NPI:1447635701
Name:GASSNER, JANEL (MS)
Entity type:Individual
Prefix:
First Name:JANEL
Middle Name:
Last Name:GASSNER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2266 N PROSPECT AVE STE 326
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-6323
Mailing Address - Country:US
Mailing Address - Phone:414-224-0492
Mailing Address - Fax:414-224-8112
Practice Address - Street 1:2266 N PROSPECT AVE STE 326
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-6323
Practice Address - Country:US
Practice Address - Phone:414-224-0492
Practice Address - Fax:414-224-8112
Is Sole Proprietor?:No
Enumeration Date:2015-07-28
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI101YA0400X101YP2500X
WI17283101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional