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605 4th St S La Crosse WI 54601-4458 | |
| (608) 386-5495 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 605 4th St S, La Crosse, Wisconsin |
| Authorized Official Name and Position | Nicole Milliren (OWNER) |
| Authorized Official Contact | 6083865495 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
605 4th St S La Crosse WI 54601-4458 Ph: (608) 386-5495 | 605 4th St S La Crosse WI 54601-4458 Ph: (608) 386-5495 |
| NPI Number | 1811580574 |
|---|---|
| Provider Enumeration Date | 02/14/2021 |
| Last Update Date | 08/15/2022 |
| Certification Date | 08/15/2022 |
| Medicare PECOS PAC ID | 8921484247 |
|---|---|
| Medicare Enrollment ID | O20221010002255 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811580574 | NPI | - | NPPES |
| 1033777800 | Medicaid | WI | |
| 100007945 | Medicaid | WI | |
| 100031418 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Nancy J Pohlman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033777800 PECOS PAC ID: 2961888292 Enrollment ID: I20221010002534 |
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