| Ames Mind Body Center | |
|
6649 Odana Rd Madison WI 53719-1011 | |
| (608) 699-9810 | |
| Not Available |
| Full Name | Ames Mind Body Center |
|---|---|
| Speciality | Psychologist |
| Location | 6649 Odana Rd, Madison, Wisconsin |
| Authorized Official Name and Position | Ian Nelson-johnson (OWNER) |
| Authorized Official Contact | 8477362917 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ames Mind Body Center 1203 Scott Ave Ames IA 50014-4039 Ph: (847) 736-2917 | Ames Mind Body Center 6649 Odana Rd Madison WI 53719-1011 Ph: (608) 699-9810 |
| NPI Number | 1669934121 |
|---|---|
| Provider Enumeration Date | 04/03/2019 |
| Last Update Date | 04/12/2023 |
| Certification Date | 04/11/2023 |
| Medicare PECOS PAC ID | 2264871359 |
|---|---|
| Medicare Enrollment ID | O20240423001258 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669934121 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Ian Nelson-johnson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1598209033 PECOS PAC ID: 4284081597 Enrollment ID: I20240423001888 |
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