| Abg Wellness Group Inc | |
|
11414 W Park Pl Ste 202 Milwaukee WI 53224-3500 | |
| (414) 292-7060 | |
| (414) 973-2090 |
| Full Name | Abg Wellness Group Inc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 11414 W Park Pl Ste 202, Milwaukee, Wisconsin |
| Authorized Official Name and Position | Alex Goldman (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 4142927060 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Abg Wellness Group Inc 11414 W Park Pl Ste 202 Milwaukee WI 53224-3500 Ph: (414) 292-7060 | Abg Wellness Group Inc 11414 W Park Pl Ste 202 Milwaukee WI 53224-3500 Ph: (414) 292-7060 |
| NPI Number | 1184087389 |
|---|---|
| Provider Enumeration Date | 04/04/2016 |
| Last Update Date | 04/04/2016 |
| Medicare PECOS PAC ID | 0345536785 |
|---|---|
| Medicare Enrollment ID | O20160909002340 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184087389 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (Wisconsin) | Primary |
| Provider Name | Deborah A Mayo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386681500 PECOS PAC ID: 1759362080 Enrollment ID: I20060120000294 |
| Provider Name | Jolie S Hersh |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225211659 PECOS PAC ID: 0547329690 Enrollment ID: I20081105000219 |
| Provider Name | Damon R Camarata |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1508127465 PECOS PAC ID: 7810151065 Enrollment ID: I20120619000576 |
| Provider Name | Eliese C Rucktenwald |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1689851313 PECOS PAC ID: 9739323304 Enrollment ID: I20130920000536 |
| Provider Name | Lora Hudson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942602040 PECOS PAC ID: 0941511901 Enrollment ID: I20150617000553 |
| Provider Name | Mercy A Mahaga |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760882229 PECOS PAC ID: 9133424468 Enrollment ID: I20160225000189 |
| Provider Name | Jodee J Kuhl |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1366884264 PECOS PAC ID: 2365734225 Enrollment ID: I20160713001438 |
| Provider Name | Stanley Rubinstein |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1316968837 PECOS PAC ID: 4789970120 Enrollment ID: I20160909002394 |
| Provider Name | Emily J Matthews |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1790193365 PECOS PAC ID: 5395032312 Enrollment ID: I20160919002689 |
| Provider Name | Tiagan T Dahl |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1801312491 PECOS PAC ID: 7315370491 Enrollment ID: I20191203002220 |
| Provider Name | Misty Budzinski |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1851865018 PECOS PAC ID: 9537573738 Enrollment ID: I20210129001457 |
| Provider Name | Meredith H Goldberg |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881000974 PECOS PAC ID: 1153735386 Enrollment ID: I20210130000017 |
| Provider Name | Laura A Harfst |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1316454887 PECOS PAC ID: 9234543463 Enrollment ID: I20210130000045 |
| Provider Name | Beth Feist |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548536097 PECOS PAC ID: 7214172279 Enrollment ID: I20210201001195 |
| Provider Name | Jeanne Mundschau-glowacki |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1720274590 PECOS PAC ID: 4284043357 Enrollment ID: I20210503001826 |
| Provider Name | Adam Sturdevant |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1457585614 PECOS PAC ID: 5092117523 Enrollment ID: I20210707000979 |
| Provider Name | Dennis Kochanik |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982378493 PECOS PAC ID: 5496146409 Enrollment ID: I20211230001613 |
| Provider Name | Travis Heipp |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1972152361 PECOS PAC ID: 1456703685 Enrollment ID: I20240123003444 |
| Provider Name | Jessica M Shipman |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1215308150 PECOS PAC ID: 6901254754 Enrollment ID: I20240311003607 |
| Provider Name | Latoya Anderson |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1366911489 PECOS PAC ID: 4385081900 Enrollment ID: I20240319001240 |
| Provider Name | Lisa S Dolgin |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1679777361 PECOS PAC ID: 0941640635 Enrollment ID: I20240429001352 |
| Provider Name | Candice Lipski |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1578891107 PECOS PAC ID: 8921281759 Enrollment ID: I20240430001444 |
| Provider Name | Jacqueline J Dernek |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1841714797 PECOS PAC ID: 7719327337 Enrollment ID: I20240430002929 |
| Provider Name | Tonyetta Ross |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1003132473 PECOS PAC ID: 1052751583 Enrollment ID: I20240501002923 |
| Provider Name | Caley Mamerow |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1306446430 PECOS PAC ID: 2668812199 Enrollment ID: I20240501003032 |
| Provider Name | Sarah M Ludeking |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1487887188 PECOS PAC ID: 0042650475 Enrollment ID: I20240501003370 |
| Provider Name | Amy J Kistner |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1700953114 PECOS PAC ID: 8729428123 Enrollment ID: I20240502001604 |
| Provider Name | Cassandra R Downey |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1255763538 PECOS PAC ID: 9032559158 Enrollment ID: I20240510001430 |
| Provider Name | Alex Goldman |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1346413515 PECOS PAC ID: 2163718503 Enrollment ID: I20240514000831 |
| Provider Name | Candy Ann Kennedy |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1639473234 PECOS PAC ID: 2163863796 Enrollment ID: I20240514003495 |
| Provider Name | William Frazer-collins |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1346514841 PECOS PAC ID: 3375984909 Enrollment ID: I20240514003758 |
| Provider Name | Matthew Velissaris |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1013341221 PECOS PAC ID: 3577904093 Enrollment ID: I20240515003024 |
| Provider Name | Leslie H Harris Spencer |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1821015272 PECOS PAC ID: 6608217104 Enrollment ID: I20240516001613 |
| Provider Name | Margot L Hoffmann |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1801364328 PECOS PAC ID: 4688016801 Enrollment ID: I20240520002733 |
| Provider Name | Lawrence F Uglow |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1720126444 PECOS PAC ID: 9032651146 Enrollment ID: I20240604004167 |
| Provider Name | Dale M Barrett |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1184881807 PECOS PAC ID: 3476095266 Enrollment ID: I20240607002360 |
| Provider Name | Samantha M Brophy |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1710243118 PECOS PAC ID: 4183166812 Enrollment ID: I20240610000321 |
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