| Chippewa Valley Neurosciences Llc | |
|
950 W Clairemont Ave Suite B Eau Claire WI 54701-6176 | |
| (715) 831-0811 | |
| (715) 831-0802 |
| Full Name | Chippewa Valley Neurosciences Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 950 W Clairemont Ave, Eau Claire, Wisconsin |
| Authorized Official Name and Position | Jon P Konzen (OWNER) |
| Authorized Official Contact | 7158310811 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Chippewa Valley Neurosciences Llc 3506 Oakwood Mall Dr Ste A Eau Claire WI 54701-2639 Ph: (715) 831-0811 | Chippewa Valley Neurosciences Llc 950 W Clairemont Ave Suite B Eau Claire WI 54701-6176 Ph: (715) 831-0811 |
| NPI Number | 1306987771 |
|---|---|
| Provider Enumeration Date | 02/09/2007 |
| Last Update Date | 05/29/2024 |
| Certification Date | 05/29/2024 |
| Medicare PECOS PAC ID | 1355494824 |
|---|---|
| Medicare Enrollment ID | O20090730000424 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306987771 | NPI | - | NPPES |
| 30067800 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | 37138021 (Wisconsin) | Primary |
| Provider Name | Jon P Konzen |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1609988310 PECOS PAC ID: 4284787755 Enrollment ID: I20090730000412 |
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