| Fennimore Healing Arts, Llc | |
|
770 Lincoln Ave Suite 2 Fennimore WI 53809-1562 | |
| (608) 572-3494 | |
| (608) 822-3812 |
| Full Name | Fennimore Healing Arts, Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 770 Lincoln Ave, Fennimore, Wisconsin |
| Authorized Official Name and Position | Rita Lease (NURSE PRACTIONER) |
| Authorized Official Contact | 6085723494 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fennimore Healing Arts, Llc 770 Lincoln Ave Suite 2 Fennimore WI 53809-1562 Ph: (608) 572-3494 | Fennimore Healing Arts, Llc 770 Lincoln Ave Suite 2 Fennimore WI 53809-1562 Ph: (608) 572-3494 |
| NPI Number | 1881024404 |
|---|---|
| Provider Enumeration Date | 11/18/2013 |
| Last Update Date | 03/31/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881024404 | NPI | - | NPPES |
| 849190006 | Other | WI | MEDICARE PTAN |
| 1215243852 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 4062-33 (Wisconsin) | Primary |
Southwest Counseling Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 1160 Lincoln Ave, Fennimore, WI 53809 Phone: 608-822-5052 Fax: 608-822-0131 |