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406 Technology Dr E Suite C Menomonie WI 54751-2767 | |
| (715) 235-4696 | |
| (715) 235-3941 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 406 Technology Dr E, Menomonie, Wisconsin |
| Authorized Official Name and Position | Paula Mickelson (CREDENTIALING MANAGER) |
| Authorized Official Contact | 7156354858 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
406 Technology Dr E Ste B Menomonie WI 54751-2768 Ph: (715) 235-4696 | 406 Technology Dr E Suite C Menomonie WI 54751-2767 Ph: (715) 235-4696 |
| NPI Number | 1437240868 |
|---|---|
| Provider Enumeration Date | 09/28/2006 |
| Last Update Date | 01/30/2025 |
| Certification Date | 01/30/2025 |
| Medicare PECOS PAC ID | 2264338391 |
|---|---|
| Medicare Enrollment ID | O20031210000266 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437240868 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Andrew J Wolf |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1871668723 PECOS PAC ID: 4587560529 Enrollment ID: I20040617000772 |
| Provider Name | Koti R Mannem |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1720188717 PECOS PAC ID: 7911964200 Enrollment ID: I20041218000041 |
| Provider Name | Madan Uprety |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1528109758 PECOS PAC ID: 6406888163 Enrollment ID: I20050902000339 |
| Provider Name | Robin R Abraham |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1063637627 PECOS PAC ID: 7719078724 Enrollment ID: I20080703000113 |
| Provider Name | Jacqueline A Perro |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073718144 PECOS PAC ID: 3577626092 Enrollment ID: I20090109000446 |
| Provider Name | Anne M Focht |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780904284 PECOS PAC ID: 7810184595 Enrollment ID: I20101207000663 |
| Provider Name | Kathleen L Ludwikowski |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073506119 PECOS PAC ID: 3476502451 Enrollment ID: I20120208000507 |
| Provider Name | Lee Phillips |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831308964 PECOS PAC ID: 2163505272 Enrollment ID: I20150217000387 |
| Provider Name | Claudia Scott |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407867187 PECOS PAC ID: 1658663232 Enrollment ID: I20180116001238 |
| Provider Name | Theodore J East |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447742838 PECOS PAC ID: 3779736855 Enrollment ID: I20181211002129 |
| Provider Name | Susan F Depasquale |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063827202 PECOS PAC ID: 4183844871 Enrollment ID: I20200122000758 |
| Provider Name | Andrew Spitznas |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1447289251 PECOS PAC ID: 4183804479 Enrollment ID: I20200130000054 |
| Provider Name | Anne Lupo-gondwe |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114538162 PECOS PAC ID: 2769845759 Enrollment ID: I20230823003252 |
| Provider Name | Matthew J Dux |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1518676402 PECOS PAC ID: 7416307921 Enrollment ID: I20231226001308 |
| Provider Name | Kayla M Petersen |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1649921362 PECOS PAC ID: 9335599521 Enrollment ID: I20240101000117 |
| Provider Name | Elizabeth Drews |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245877810 PECOS PAC ID: 2567904642 Enrollment ID: I20240604003023 |
| Provider Name | Lisa Metza-peterson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1326513862 PECOS PAC ID: 4486196938 Enrollment ID: I20240612002665 |
| Provider Name | Abbey J Dieckman |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1427322759 PECOS PAC ID: 3072051747 Enrollment ID: I20240813000620 |
Arbor Place, Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 4076 Kothlow Ave, Menomonie, WI 54751 Phone: 715-235-4537 Fax: 715-235-4535 | |
Soulutions Holistic Center & Institute Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1700 Tainter St Ste F, Menomonie, WI 54751 Phone: 715-231-4014 | |
Red Cedar Psychology Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 3120 Schneider Ave Se Ste 606, Menomonie, WI 54751 Phone: 715-505-6105 | |
Beacon Mental Health Resources Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1421 Broadway St N Ste 114b, Menomonie, WI 54751 Phone: 715-308-5742 Fax: 888-972-4831 |