Gretchen Dominowski, LPC-IT, SAC-IT in Menasha, WI

Gretchen Dominowski, LPC-IT, SAC-IT is a medicare enrolled "Counselor - Mental Health" provider in Menasha, Wisconsin. Her current practice location is 1810 Appleton Rd, Menasha, Wisconsin. You can reach out to her office (for appointments etc.) via phone at (920) 739-4226.

Gretchen Dominowski is licensed to practice in Wisconsin (license number 4648-226) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1598381659.

Contact Information

	Gretchen Dominowski, LPC-IT, SAC-IT
	1810 Appleton Rd, Menasha, WI 54952-1110
	(920) 739-4226
	(920) 432-5966

Map and Direction

Healthcare Provider's Profile

Full Name	Gretchen Dominowski
Gender	Female
Speciality	Counselor - Mental Health
Location	1810 Appleton Rd, Menasha, Wisconsin
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1598381659
Provider Enumeration Date: 06/24/2020
Last Update Date: 12/18/2020

Medicare PECOS Information:

PECOS PAC ID: 4082158373
Enrollment ID: I20240627001717

Medical Identifiers

Medical identifiers for Gretchen Dominowski such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1598381659	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
101YA0400X	Counselor - Addiction (substance Use Disorder)	19223 (Wisconsin)	Secondary
101YM0800X	Counselor - Mental Health	4648-226 (Wisconsin)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Gretchen Dominowski allows following entities to bill medicare on her behalf.

Entity Name	Jacob's Well Counseling Center Inc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1609558485 PECOS PAC ID: 1456799006 Enrollment ID: O20240402003439

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Gretchen Dominowski is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Gretchen Dominowski, LPC-IT, SAC-IT Po Box 22308, Green Bay, WI 54305-2308 Ph: (920) 436-6800	Gretchen Dominowski, LPC-IT, SAC-IT 1810 Appleton Rd, Menasha, WI 54952-1110 Ph: (920) 739-4226

Reviews and Comments

Counselor in Menasha, WI

Mr. Michael G. Frost, RADCI Counselor Medicare: Medicare Enrolled Practice Location: 1201 Tuckaway Ln, Menasha, WI 54952 Phone: 920-733-4443 Fax: 920-733-4796
Darlene Leary, Counselor Medicare: Not Enrolled in Medicare Practice Location: 1095 Midway Rd, Menasha, WI 54952 Phone: 920-720-2300
Lisa Bredael, Counselor Medicare: Medicare Enrolled Practice Location: 1095 Midway Rd, Menasha, WI 54952 Phone: 920-720-2300
Lynne Drews, Counselor Medicare: Not Enrolled in Medicare Practice Location: 1095 Midway Rd, Menasha, WI 54952 Phone: 920-720-2300
Shauna S Vanden Hoogen, SAC Counselor Medicare: Not Enrolled in Medicare Practice Location: 1095 Midway Rd, Menasha, WI 54952 Phone: 920-720-3700
Amber Leigh Greuel, LPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 1095 Midway Rd, Menasha, WI 54952 Phone: 920-720-2300
Sergio Guerrero, LPC-IT Counselor Medicare: Medicare Enrolled Practice Location: 1478 Kenwood Dr Ste 1, Menasha, WI 54952 Phone: 920-886-9319

Gretchen Dominowski, LPC-IT, SAC-IT - Medicare Counselor in Menasha, WI