Angela Gardebrecht

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

16546 Issued in WI

Practice address

300 Crooks St
Green Bay, WI 54301-4527

Phone

(920) 436-4360

Fax

(920) 432-5966

NPI assigned

Oct 7, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• CCP Clinic, LLC

  • Clinical Psychologist
  • De Pere, WI
  • NPI 1396431714
  Medicare reassignment NPD

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

{
    "created_epoch": "1444176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1550793600000",
    "number": "1730559451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 CROOKS ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543014527",
            "telephone_number": "920-436-4360",
            "fax_number": "920-432-5966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 CROOKS ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543014527",
            "telephone_number": "920-436-4360",
            "fax_number": "920-432-5966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARDEBRECHT",
        "first_name": "ANGELA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-10-07",
        "last_updated": "2019-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "16546",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Khushboo M Gandhi, M.D.
• Mary P Gantz, PT
• James P Gapinski, MD
• Peter V Gapinski, MD
• Rene Garcia, CRNA
• Celia J Gardner, LPC
• Gregory S Gardner, D.D.S.
• Jennifer L Gardner, LPN
• Kristin Marie Gardon, NP
• Mark A Gardon, MD

• Addiction (Substance Use Disorder) Counselor in Green Bay, WI
• Providers in Green Bay, WI by specialty
• Addiction (Substance Use Disorder) Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.