| Lakefront Wellness Center, Sc | |
|
161 W Wisconsin Ave Ste 2b Pewaukee WI 53072-3468 | |
| (262) 695-8857 | |
| (262) 695-8879 |
| Full Name | Lakefront Wellness Center, Sc |
|---|---|
| Speciality | Psychologist |
| Location | 161 W Wisconsin Ave Ste 2b, Pewaukee, Wisconsin |
| Authorized Official Name and Position | Beth A. Johnson (DIRECTOR) |
| Authorized Official Contact | 2626958857 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakefront Wellness Center, Sc 161 W Wisconsin Ave Ste 2b Pewaukee WI 53072-3468 Ph: (262) 695-8857 | Lakefront Wellness Center, Sc 161 W Wisconsin Ave Ste 2b Pewaukee WI 53072-3468 Ph: (262) 695-8857 |
| NPI Number | 1316024847 |
|---|---|
| Provider Enumeration Date | 11/01/2006 |
| Last Update Date | 08/27/2013 |
| Medicare PECOS PAC ID | 5193719334 |
|---|---|
| Medicare Enrollment ID | O20040412000962 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316024847 | NPI | - | NPPES |
| 42230900 | Medicaid | WI |
| Provider Name | Kim M Gorecki |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1649361775 PECOS PAC ID: 8426062142 Enrollment ID: I20060202000277 |
| Provider Name | Beth A Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1811925613 PECOS PAC ID: 6608860853 Enrollment ID: I20060302000696 |
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