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5703 Memorial Ct Weston WI 54476-6502 | |
| (715) 204-9808 | |
| Not Available |
| Full Name | |
|---|---|
| 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 |
|---|---|
5703 Memorial Ct Weston WI 54476-6502 Ph: (715) 204-9808 | 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 | David R Winemiller |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1659472470 PECOS PAC ID: 1456485382 Enrollment ID: I20100814000076 |
| Provider Name | Valorie A Helander |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1699859843 PECOS PAC ID: 3577745314 Enrollment ID: I20110315000712 |
| Provider Name | Tina Marie Baeten |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1386793248 PECOS PAC ID: 8224299870 Enrollment ID: I20120409000437 |
| Provider Name | Trisha Stefonek |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1376764134 PECOS PAC ID: 3678919685 Enrollment ID: I20240313001478 |
| Provider Name | Jessica Goodrich |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1720742950 PECOS PAC ID: 8426408055 Enrollment ID: I20240418003192 |
| Provider Name | Gabrielle Marie Weber |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003673104 PECOS PAC ID: 9335685064 Enrollment ID: I20240718001431 |
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