Driftless Area Behavioral Services, Llc | |
1250 E Business Highway 151 Ste D Platteville WI 53818-3875 | |
(608) 470-2200 | |
Not Available |
Full Name | Driftless Area Behavioral Services, Llc |
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Speciality | Social Worker |
Location | 1250 E Business Highway 151 Ste D, Platteville, Wisconsin |
Authorized Official Name and Position | Stacey Richard-baal (MEMBER) |
Authorized Official Contact | 5635812064 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Driftless Area Behavioral Services, Llc Po Box 632 Platteville WI 53818-0632 Ph: (608) 470-2200 | Driftless Area Behavioral Services, Llc 1250 E Business Highway 151 Ste D Platteville WI 53818-3875 Ph: (608) 470-2200 |
NPI Number | 1982374344 |
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Provider Enumeration Date | 09/16/2021 |
Last Update Date | 09/16/2021 |
Certification Date | 09/16/2021 |
Medicare PECOS PAC ID | 6002205895 |
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Medicare Enrollment ID | O20211117000598 |
Identifier | Type | State | Issuer |
---|---|---|---|
1982374344 | NPI | - | NPPES |
10172-33 | Other | WI | STATE LICENSURE |
7672-123 | Other | WI | STATE LICENSURE |
132167-121 | Other | WI | STATE LICENSURE |
8731-123 | Other | WI | STATE LICENSURE |
9664-120 | Other | WI | STATE LICENSURE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
Provider Name | Jennifer B Kropp |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1205884087 PECOS PAC ID: 4082789235 Enrollment ID: I20110325000385 |
Provider Name | Emily Ann Longhenry |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1730339417 PECOS PAC ID: 6709186331 Enrollment ID: I20200812001626 |
Provider Name | Andrea Ann Kaiser |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1649905381 PECOS PAC ID: 1759764111 Enrollment ID: I20220817002149 |
Provider Name | Cecelia Ann Greenwood |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1689262628 PECOS PAC ID: 2264808310 Enrollment ID: I20221014002172 |
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