| Intentional Psychology Llc | |
|
9205 W Center St Ste 200 Milwaukee WI 53222-4548 | |
| (414) 279-9082 | |
| (414) 231-3561 |
| Full Name | Intentional Psychology Llc |
|---|---|
| Speciality | Psychologist |
| Location | 9205 W Center St Ste 200, Milwaukee, Wisconsin |
| Authorized Official Name and Position | Shanna R Thomsen (OWNER) |
| Authorized Official Contact | 4142799082 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Intentional Psychology Llc 9205 W Center St Ste 200 Milwaukee WI 53222-4548 Ph: (414) 279-9082 | Intentional Psychology Llc 9205 W Center St Ste 200 Milwaukee WI 53222-4548 Ph: (414) 279-9082 |
| NPI Number | 1699469411 |
|---|---|
| Provider Enumeration Date | 06/05/2023 |
| Last Update Date | 06/05/2023 |
| Certification Date | 06/05/2023 |
| Medicare PECOS PAC ID | 7416315247 |
|---|---|
| Medicare Enrollment ID | O20230626002994 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699469411 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Shanna Thomsen |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1417438250 PECOS PAC ID: 6204232531 Enrollment ID: I20210910002168 |
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