Holly Jane Gardenier, MS, LPC, CSAC, ICS

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

4187-125 Issued in WI

Practice address

W62N248 Washington Ave
Suite 207
Cedarburg, WI 53012-2768

Phone

(414) 545-1950

Fax

(262) 375-1071

NPI assigned

Mar 16, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Northshore Clinic & Consultants, Inc.

  • Community/Behavioral Health Agency
  • Cedarburg, WI
  • NPI 1720201163
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1285545600000",
    "number": "1669506846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "221 E CLOVERNOOK LN",
            "city": "FOX POINT",
            "state": "WI",
            "postal_code": "532174217",
            "telephone_number": "414-881-8097",
            "fax_number": "262-375-1071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "W62N248 WASHINGTON AVE",
            "address_2": "SUITE 207",
            "city": "CEDARBURG",
            "state": "WI",
            "postal_code": "530122768",
            "telephone_number": "414-545-1950",
            "fax_number": "262-375-1071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARDENIER",
        "first_name": "HOLLY",
        "middle_name": "JANE",
        "credential": "MS, LPC, CSAC, ICS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-16",
        "last_updated": "2010-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "WI",
            "license": "14743133",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "4187-125",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "15306-132",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42025100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Cedarburg, WI
• Providers in Cedarburg, WI by specialty
• Professional Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.