| Bh Outpatient Services | |
|
111 W Jackson St Wisconsin Rapids WI 54495-2702 | |
| (715) 421-8800 | |
| (715) 421-2266 |
| Full Name | Bh Outpatient Services |
|---|---|
| Speciality | Counselor |
| Location | 111 W Jackson St, Wisconsin Rapids, Wisconsin |
| Authorized Official Name and Position | Brandon Vruwink (DIRECTOR - HUMAN SERVICES) |
| Authorized Official Contact | 7154218800 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bh Outpatient Services 2611 12th St S Wisconsin Rapids WI 54494-6445 Ph: (715) 421-8800 | Bh Outpatient Services 111 W Jackson St Wisconsin Rapids WI 54495-2702 Ph: (715) 421-8800 |
| NPI Number | 1063638088 |
|---|---|
| Provider Enumeration Date | 04/18/2007 |
| Last Update Date | 09/09/2022 |
| Certification Date | 09/09/2022 |
| Medicare PECOS PAC ID | 3476554692 |
|---|---|
| Medicare Enrollment ID | O20080522000193 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063638088 | NPI | - | NPPES |
| 42140800 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 2019 (Wisconsin) | Secondary |
| 101YP2500X | Counselor - Professional | 2019 (Wisconsin) | Primary |
| Provider Name | Suzanne B Grimm |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1245345230 PECOS PAC ID: 5991737975 Enrollment ID: I20050910000208 |
| Provider Name | Stephanie D Gudmunsen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407941446 PECOS PAC ID: 7315090123 Enrollment ID: I20090727000537 |
| Provider Name | David R Winemiller |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1659472470 PECOS PAC ID: 1456485382 Enrollment ID: I20100814000076 |
| Provider Name | Adebowale Mofikoya |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1275794422 PECOS PAC ID: 0143477166 Enrollment ID: I20130726000394 |
| Provider Name | Sheila C Rao |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1831112374 PECOS PAC ID: 3375597404 Enrollment ID: I20150807013359 |
| Provider Name | Demaris L Losinski |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1437554441 PECOS PAC ID: 1153611801 Enrollment ID: I20160608001172 |
| Provider Name | Jessica Kaye Keyzer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1912527102 PECOS PAC ID: 7113357674 Enrollment ID: I20200423002536 |
| Provider Name | Lori Ann Kroening |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346656469 PECOS PAC ID: 4587040100 Enrollment ID: I20221005003160 |
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