| Hope Road Wellness Center, Llc | |
|
107 Hope Road West Frederic WI 54837-0383 | |
| (715) 491-5365 | |
| (800) 684-2131 |
| Full Name | Hope Road Wellness Center, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 107 Hope Road West, Frederic, Wisconsin |
| Authorized Official Name and Position | Kristina M Thompson (MENTAL HEALTH CLINICIAN) |
| Authorized Official Contact | 7154915365 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Hope Road Wellness Center, Llc Po Box 383 Frederic WI 54837-0383 Ph: (715) 869-6484 | Hope Road Wellness Center, Llc 107 Hope Road West Frederic WI 54837-0383 Ph: (715) 491-5365 |
| NPI Number | 1588158679 |
|---|---|
| Provider Enumeration Date | 06/21/2018 |
| Last Update Date | 07/30/2024 |
| Certification Date | 07/30/2024 |
| Medicare PECOS PAC ID | 8224384649 |
|---|---|
| Medicare Enrollment ID | O20180627001763 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588158679 | NPI | - | NPPES |
| 1689004426 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 8287 (Wisconsin) | Primary |
| Provider Name | Kristina M Thompson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1689004426 PECOS PAC ID: 4183856669 Enrollment ID: I20170202002451 |
Northwest Counseling & Guidance Clinic Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 203 United Way Drive, Frederic, WI 54837 Phone: 715-327-4402 Fax: 715-327-4470 |