Lotus | |
32 S Main St Janesville WI 53545-3941 | |
(608) 618-5560 | |
(855) 277-9589 |
Full Name | Lotus |
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Speciality | Social Worker |
Location | 32 S Main St, Janesville, Wisconsin |
Authorized Official Name and Position | Krystal A Conkle (OWNER/THERAPIST) |
Authorized Official Contact | 6086185560 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Lotus 32 S Main St Janesville WI 53545-3941 Ph: (608) 618-5560 | Lotus 32 S Main St Janesville WI 53545-3941 Ph: (608) 618-5560 |
NPI Number | 1972077527 |
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Provider Enumeration Date | 01/16/2019 |
Last Update Date | 10/16/2023 |
Certification Date | 10/16/2023 |
Medicare PECOS PAC ID | 1658720263 |
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Medicare Enrollment ID | O20231207003288 |
Identifier | Type | State | Issuer |
---|---|---|---|
1972077527 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
Provider Name | Mary K Wolf |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1154308419 PECOS PAC ID: 9436280187 Enrollment ID: I20160511001692 |
Provider Name | Jaime Lynn Kremer |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1912413782 PECOS PAC ID: 9931447208 Enrollment ID: I20190212000881 |
Provider Name | Krystal A Conkle |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1972041317 PECOS PAC ID: 2567811177 Enrollment ID: I20231207003408 |
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