Provider Demographics
NPI:1659721371
Name:GUTSMIEDL, CARISSA MARIE (MA, LPC)
Entity type:Individual
Prefix:MS
First Name:CARISSA
Middle Name:MARIE
Last Name:GUTSMIEDL
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:MRS
Other - First Name:CARISSA
Other - Middle Name:MARIE
Other - Last Name:SAWICKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:527 LILAC ST
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54902-5523
Mailing Address - Country:US
Mailing Address - Phone:920-562-3793
Mailing Address - Fax:
Practice Address - Street 1:8931 HURON ST
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80260-6806
Practice Address - Country:US
Practice Address - Phone:303-853-3500
Practice Address - Fax:303-853-3702
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-14
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7938-125101YM0800X
COLPC.0018023101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100103270Medicaid
IL376001106006Medicaid
IL376001106007Medicaid