| Michelle M Runnion, MS, LPC | |
|
6233 39th Ave, Kenosha, WI 53142-7015 | |
| (262) 654-1004 | |
| (262) 654-6960 |
| Full Name | Michelle M Runnion |
|---|---|
| Gender | Female |
| Speciality | Counselor - Professional |
| Location | 6233 39th Ave, Kenosha, Wisconsin |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912117318 | NPI | - | NPPES |
| 39752900 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 12685 (Wisconsin) | Secondary |
| 101YP2500X | Counselor - Professional | 2989-125 (Wisconsin) | Primary |
| Entity Name | Professional Services Group Inc. |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1619024262 PECOS PAC ID: 8224296454 Enrollment ID: O20120220000742 |
| Mailing Address | Practice Location Address |
|---|---|
| Michelle M Runnion, MS, LPC 6233 39th Ave, Kenosha, WI 53142-7015 Ph: (262) 654-1004 | Michelle M Runnion, MS, LPC 6233 39th Ave, Kenosha, WI 53142-7015 Ph: (262) 654-1004 |
La Shanda Tolefree, BA, MS Counselor Medicare: Medicare Enrolled Practice Location: 3536 52nd St, Kenosha, WI 53144 Phone: 262-842-0538 Fax: 262-842-0539 | |
Ann M Grossman, MS, LPC-IT Counselor Medicare: Not Enrolled in Medicare Practice Location: 6321 23rd Ave, Kenosha, WI 53143 Phone: 414-455-3879 Fax: 866-719-3024 | |
Stephanie L Mayberry, LPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 6127 Green Bay Rd Ste 200, Kenosha, WI 53142 Phone: 262-654-8366 Fax: 262-842-0444 | |
Jami Lynn Pomeroy, LPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 1400 75th St, Kenosha, WI 53143 Phone: 262-909-6008 | |
Kathleen M Bullard, MS, LPC-IT, SAC-IT Counselor Medicare: Not Enrolled in Medicare Practice Location: 4003 80th St Ste 101, Kenosha, WI 53142 Phone: 262-806-1467 Fax: 262-661-7702 | |
Monica Christian, LPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 2108 63rd St, Kenosha, WI 53143 Phone: 262-652-2406 | |
Jessica Martzahl, LPC Counselor Medicare: Medicare Enrolled Practice Location: 2108 63rd St, Kenosha, WI 53143 Phone: 262-652-2406 |