| Weston Psychiatric | |
|
5703 Memorial Ct Weston WI 54476-6502 | |
| (715) 204-9808 | |
| Not Available |
| Full Name | Weston Psychiatric |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 5703 Memorial Ct, Weston, Wisconsin |
| Authorized Official Name and Position | Robert Gouthro (OWNER) |
| Authorized Official Contact | 7152049808 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Weston Psychiatric 5703 Memorial Ct Weston WI 54476-6502 Ph: (715) 204-9808 | Weston Psychiatric 5703 Memorial Ct Weston WI 54476-6502 Ph: (715) 204-9808 |
| NPI Number | 1255048633 |
|---|---|
| Provider Enumeration Date | 11/03/2022 |
| Last Update Date | 08/29/2024 |
| Certification Date | 08/29/2024 |
| Medicare PECOS PAC ID | 4082053616 |
|---|---|
| Medicare Enrollment ID | O20240416002264 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255048633 | NPI | - | NPPES |
| Provider Name | Robert Vincent Gouthro |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1285752089 PECOS PAC ID: 5698813509 Enrollment ID: I20091113000391 |
| Provider Name | Trisha Stefonek |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1376764134 PECOS PAC ID: 3678919685 Enrollment ID: I20240313001478 |
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