Provider Demographics
NPI:1538276720
Name:GEBHARD, LAURI CHRISTINE (PHD)
Entity type:Individual
Prefix:DR
First Name:LAURI
Middle Name:CHRISTINE
Last Name:GEBHARD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15300 WATERTOWN PLANK RD STE 106
Mailing Address - Street 2:
Mailing Address - City:ELM GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53122-2348
Mailing Address - Country:US
Mailing Address - Phone:414-807-8934
Mailing Address - Fax:414-302-1330
Practice Address - Street 1:15300 WATERTOWN PLANK RD STE 106
Practice Address - Street 2:
Practice Address - City:ELM GROVE
Practice Address - State:WI
Practice Address - Zip Code:53122-2348
Practice Address - Country:US
Practice Address - Phone:414-807-8934
Practice Address - Fax:414-302-1330
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIWI2028103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39121000Medicaid
44485OtherNATIONAL REGISTER
84972Medicare ID - Type Unspecified