Provider Demographics
NPI:1871056606
Name:GUREVICH, ANNA (CAPSW)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:GUREVICH
Suffix:
Gender:F
Credentials:CAPSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 WINCHESTER WAY
Mailing Address - Street 2:
Mailing Address - City:WAUNAKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53597-2008
Mailing Address - Country:US
Mailing Address - Phone:608-215-4442
Mailing Address - Fax:
Practice Address - Street 1:700 REGENT ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-2634
Practice Address - Country:US
Practice Address - Phone:608-567-4465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-09
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI131355-121101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health