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21 N Portland St Ste 2b Fond Du Lac WI 54935-3465 | |
| (920) 630-1324 | |
| (920) 479-2870 |
| Full Name | |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 21 N Portland St Ste 2b, Fond Du Lac, Wisconsin |
| Authorized Official Name and Position | Alicia Hans (OWNER) |
| Authorized Official Contact | 9206301324 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
21 N Portland St Ste 2b Fond Du Lac WI 54935-3465 Ph: (920) 630-1324 | 21 N Portland St Ste 2b Fond Du Lac WI 54935-3465 Ph: (920) 630-1324 |
| NPI Number | 1184369142 |
|---|---|
| Provider Enumeration Date | 05/03/2022 |
| Last Update Date | 01/27/2025 |
| Certification Date | 01/27/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184369142 | NPI | - | NPPES |
| 1000880618 | Medicaid | WI | |
| 1962982421 | Other | WI | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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