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106 Galvin Road Abbotsford WI 54405 | |
| (715) 223-0480 | |
| (715) 223-1611 |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 106 Galvin Road, Abbotsford, Wisconsin |
| Authorized Official Name and Position | Raeann Wichlacz (OWNER) |
| Authorized Official Contact | 7152230480 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 447 106 Galvin Road Abbotsford WI 54405 Ph: (715) 223-0480 | 106 Galvin Road Abbotsford WI 54405 Ph: (715) 223-0480 |
| NPI Number | 1508840992 |
|---|---|
| Provider Enumeration Date | 11/30/2005 |
| Last Update Date | 06/13/2008 |
| Medicare PECOS PAC ID | 3678623675 |
|---|---|
| Medicare Enrollment ID | O20090612000495 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508840992 | NPI | - | NPPES |
| 42215300 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 11042 (Wisconsin) | Primary |
| Provider Name | Becca L Greub |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1720477185 PECOS PAC ID: 9032425848 Enrollment ID: I20160105001482 |
| Provider Name | Raeann Wichlacz |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1942253315 PECOS PAC ID: 9032269030 Enrollment ID: I20240304001459 |