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12630 W North Ave Bldg E Brookfield WI 53005-4626 | |
| (262) 785-1008 | |
| (262) 462-3187 |
| Full Name | |
|---|---|
| Speciality | Psychologist |
| Location | 12630 W North Ave Bldg E, Brookfield, Wisconsin |
| Authorized Official Name and Position | Jennifer Mengo (ADMINISTRATOR) |
| Authorized Official Contact | 2627851008 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
12630 W North Ave Bldg E Brookfield WI 53005-4626 Ph: (262) 785-1008 | 12630 W North Ave Bldg E Brookfield WI 53005-4626 Ph: (262) 785-1008 |
| NPI Number | 1659466860 |
|---|---|
| Provider Enumeration Date | 10/04/2006 |
| Last Update Date | 04/26/2018 |
| Medicare PECOS PAC ID | 8325046162 |
|---|---|
| Medicare Enrollment ID | O20061110000142 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659466860 | NPI | - | NPPES |
| Provider Name | Eric Don Seybold |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1427002211 PECOS PAC ID: 3779581277 Enrollment ID: I20061116000492 |
| Provider Name | Tanya L Gerhard |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1366459646 PECOS PAC ID: 7416955919 Enrollment ID: I20061220000473 |
| Provider Name | Judith A Otto |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1982611265 PECOS PAC ID: 0648374975 Enrollment ID: I20070327000269 |
| Provider Name | Linda A Zacharias |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1134264369 PECOS PAC ID: 8527218460 Enrollment ID: I20121030000360 |
| Provider Name | Michael Schachtner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447769039 PECOS PAC ID: 6800150210 Enrollment ID: I20180511002054 |
| Provider Name | Rebecca Rae Breitrick |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1477069458 PECOS PAC ID: 0143751487 Enrollment ID: I20240927000793 |
| Provider Name | Sarah Fesser |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1669876868 PECOS PAC ID: 9032640156 Enrollment ID: I20241001000303 |
| Provider Name | Alison Leigh Jacobs |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1619352184 PECOS PAC ID: 8921539040 Enrollment ID: I20241001000381 |
| Provider Name | Cedric Dale Hoard |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1497261341 PECOS PAC ID: 4688108657 Enrollment ID: I20241113002604 |
| Provider Name | Emily Kathryn Olson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1023632635 PECOS PAC ID: 9739614967 Enrollment ID: I20241126000317 |
| Provider Name | Trisha Lynn Frederick |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1487947578 PECOS PAC ID: 9133654221 Enrollment ID: I20241126003107 |
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