Provider Demographics
NPI:1710868534
Name:HUSAK, GENEVIEVE SUZANNE
Entity type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:SUZANNE
Last Name:HUSAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6131 NESBITT RD STE 200
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53719-1891
Mailing Address - Country:US
Mailing Address - Phone:608-203-6267
Mailing Address - Fax:
Practice Address - Street 1:6131 NESBITT RD STE 200
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53719-1891
Practice Address - Country:US
Practice Address - Phone:608-203-6267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-09
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8692-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional