| Northeast Wisconsin Behavioral Health Sc | |
|
529 South Jefferson Street Suite 202 Green Bay WI 54301-4125 | |
| (920) 884-2175 | |
| (920) 884-6735 |
| Full Name | Northeast Wisconsin Behavioral Health Sc |
|---|---|
| Speciality | Counselor |
| Location | 529 South Jefferson Street, Green Bay, Wisconsin |
| Authorized Official Name and Position | Suzette Marie Kosnar-tittl (OWNER, CEO, PROVIDER) |
| Authorized Official Contact | 9208842175 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Northeast Wisconsin Behavioral Health Sc 529 South Jefferson Street Suite 202 Green Bay WI 54301-4125 Ph: (920) 884-2175 | Northeast Wisconsin Behavioral Health Sc 529 South Jefferson Street Suite 202 Green Bay WI 54301-4125 Ph: (920) 884-2175 |
| NPI Number | 1275733602 |
|---|---|
| Provider Enumeration Date | 07/24/2007 |
| Last Update Date | 10/16/2023 |
| Medicare PECOS PAC ID | 9436245230 |
|---|---|
| Medicare Enrollment ID | O20071009000791 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275733602 | NPI | - | NPPES |
| 39722900 | Other | WI | PROVIDER MEDICAID # |
| 000044900 | Other | WI | CLINICMEDICARE# GREENBAY |
| 1275733602 | Other | WI | CLINIC NPI# |
| 000044905 | Other | WI | CLINICMEDICARE#OSHKOSH |
| 1285736249 | Other | PROVIDER NPI | |
| 000144900 | Other | WI | PROVIDERMEDICARE#GREENBAY |
| 000144905 | Other | WI | PROVIDERMEDICARE#OSHKOSH |
| 4225100 | Other | WI | CLINIC MEDICAID # |
| Provider Name | Suzette Marie Kosnar-tittl |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1285736249 PECOS PAC ID: 6204731722 Enrollment ID: I20031205000709 |
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