| Living For Liberation | |
|
111 Warren St Ste 2 Beaver Dam WI 53916-3084 | |
| (262) 226-0391 | |
| Not Available |
| Full Name | Living For Liberation |
|---|---|
| Speciality | Social Worker |
| Location | 111 Warren St Ste 2, Beaver Dam, Wisconsin |
| Authorized Official Name and Position | Shannon Bernice Westphal (PSYCHOTHERAPIST) |
| Authorized Official Contact | 2622260391 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Living For Liberation Po Box 131 Hustisford WI 53034-0131 Ph: (262) 224-7721 | Living For Liberation 111 Warren St Ste 2 Beaver Dam WI 53916-3084 Ph: (262) 226-0391 |
| NPI Number | 1194423830 |
|---|---|
| Provider Enumeration Date | 02/22/2023 |
| Last Update Date | 05/12/2023 |
| Certification Date | 05/12/2023 |
| Medicare PECOS PAC ID | 0143686790 |
|---|---|
| Medicare Enrollment ID | O20230524000610 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194423830 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Shannon Bernice Westphal |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245819200 PECOS PAC ID: 9436523347 Enrollment ID: I20230316000148 |
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