| Growing Oak Llc | |
|
112 Watson St Ripon WI 54971-1327 | |
| (920) 896-0189 | |
| (920) 694-3021 |
| Full Name | Growing Oak Llc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 112 Watson St, Ripon, Wisconsin |
| Authorized Official Name and Position | Lindsay Loewe (MENTAL HEALTH & SUBSTANCE ABUSE) |
| Authorized Official Contact | 6084691753 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Growing Oak Llc 112 Watson St Ripon WI 54971-1327 Ph: (920) 896-0189 | Growing Oak Llc 112 Watson St Ripon WI 54971-1327 Ph: (920) 896-0189 |
| NPI Number | 1306195276 |
|---|---|
| Provider Enumeration Date | 09/06/2012 |
| Last Update Date | 09/06/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306195276 | NPI | - | NPPES |
| 1235417593 | Other | INDIVIDUAL NPI NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 4622-125 (Wisconsin) | Secondary |
| 101YP2500X | Counselor - Professional | 4622-125 (Wisconsin) | Primary |
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