| Forward Choices, Llc | |
|
6040 W Lisbon Ave Ste 103 Milwaukee WI 53210-2116 | |
| (414) 442-1751 | |
| (414) 442-1775 |
| Full Name | Forward Choices, Llc |
|---|---|
| Speciality | Counselor |
| Location | 6040 W Lisbon Ave Ste 103, Milwaukee, Wisconsin |
| Authorized Official Name and Position | Michael Leo Wallner (OWNER) |
| Authorized Official Contact | 4144421751 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Forward Choices, Llc 140 N Hine Ave Waukesha WI 53188-4316 Ph: (414) 442-1751 | Forward Choices, Llc 6040 W Lisbon Ave Ste 103 Milwaukee WI 53210-2116 Ph: (414) 442-1751 |
| NPI Number | 1275791485 |
|---|---|
| Provider Enumeration Date | 05/26/2008 |
| Last Update Date | 11/10/2011 |
| Medicare PECOS PAC ID | 6204016959 |
|---|---|
| Medicare Enrollment ID | O20110211000851 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275791485 | NPI | - | NPPES |
| 2785 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 3935-125 (Wisconsin) | Primary |
| Provider Name | Jennifer L Stagg |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609906015 PECOS PAC ID: 3678809555 Enrollment ID: I20190730003811 |
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