| Mikhaela Creekmore Llc | |
|
4539 Woodgate Dr Ste A8 Janesville WI 53546-8205 | |
| (608) 201-0591 | |
| Not Available |
| Full Name | Mikhaela Creekmore Llc |
|---|---|
| Speciality | Social Worker |
| Location | 4539 Woodgate Dr Ste A8, Janesville, Wisconsin |
| Authorized Official Name and Position | Mikhaela Creekmore (CEO) |
| Authorized Official Contact | 6082010591 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mikhaela Creekmore Llc 4754 Sumpter Dr Milton WI 53563-8417 Ph: (608) 201-0591 | Mikhaela Creekmore Llc 4539 Woodgate Dr Ste A8 Janesville WI 53546-8205 Ph: (608) 201-0591 |
| NPI Number | 1306689617 |
|---|---|
| Provider Enumeration Date | 06/14/2024 |
| Last Update Date | 06/14/2024 |
| Certification Date | 06/13/2024 |
| Medicare PECOS PAC ID | 3375080773 |
|---|---|
| Medicare Enrollment ID | O20240802002263 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306689617 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Mikhaela Creekmore |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1689026965 PECOS PAC ID: 2466893466 Enrollment ID: I20240508001311 |
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