Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Gretchen Dominowski, LPC-IT, SAC-IT

Individual provider Addiction (Substance Use Disorder) Counselor · NPI 1598381659

Gretchen Dominowski, LPC-IT, SAC-IT is a Mental Health Counselor in Menasha, Wisconsin. Qualified in 2020, 6 years ago. Practices with Jacob's Well Counseling Center Inc, a 3-clinician group. Licensed in Wisconsin.

Years since qualifying
6
Licensed in
WI
In the registry since
2020
Specialties on file
2
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Practice location Address checks out

1810 Appleton Rd
Menasha, WI 54952-1110
Phone: (920) 739-4226
Fax: (920) 432-5966
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Mental Health Counselor (primary) Taxonomy 101YM0800X · Licence 4648-226 (WI)
Addiction (Substance Use Disorder) Counselor Taxonomy 101YA0400X · Licence 19223 (WI)

Record details

NPI number1598381659
Entity typeIndividual (Type 1)
GenderFemale
Credentials LPC-IT , SAC-IT
Sole proprietorNo
NPI enumeratedJune 24, 2020
Last updated in NPPESDecember 18, 2020
Certification dateDecember 18, 2020

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyMENTAL HEALTH COUNSELOR
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Jacob'S Well Counseling Center Inc — 3 clinicians
Accepts Medicare assignment Not indicated

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