| Joanne Berthelsen Lcsw Llc | |
|
830 Armour Rd Ste 2 Oconomowoc WI 53066-3959 | |
| (262) 235-2350 | |
| (235) 804-8132 |
| Full Name | Joanne Berthelsen Lcsw Llc |
|---|---|
| Speciality | Social Worker |
| Location | 830 Armour Rd Ste 2, Oconomowoc, Wisconsin |
| Authorized Official Name and Position | Joanne Berthelsen (OWNER/PROVIDER) |
| Authorized Official Contact | 2622352350 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Joanne Berthelsen Lcsw Llc 830 Armour Rd Ste 2 Oconomowoc WI 53066-3959 Ph: (262) 235-2350 | Joanne Berthelsen Lcsw Llc 830 Armour Rd Ste 2 Oconomowoc WI 53066-3959 Ph: (262) 235-2350 |
| NPI Number | 1124657721 |
|---|---|
| Provider Enumeration Date | 04/06/2020 |
| Last Update Date | 04/06/2020 |
| Certification Date | 04/06/2020 |
| Medicare PECOS PAC ID | 7911338066 |
|---|---|
| Medicare Enrollment ID | O20200506000375 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124657721 | NPI | - | NPPES |
| 100071305 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Joanne M Berthelsen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1831614049 PECOS PAC ID: 2062788078 Enrollment ID: I20171018003594 |
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