| Northwest Journey-depere | |
|
1119 W Kennedy Ave Ste A Kimberly WI 54136-2213 | |
| (920) 364-9668 | |
| (888) 625-8634 |
| Full Name | Northwest Journey-depere |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 1119 W Kennedy Ave, Kimberly, Wisconsin |
| Authorized Official Name and Position | Jackie J Maurer (OFFICE SUPERVISOR) |
| Authorized Official Contact | 7153497069 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Northwest Journey-depere Po Box 309 Siren WI 54872-0309 Ph: (715) 349-7069 | Northwest Journey-depere 1119 W Kennedy Ave Ste A Kimberly WI 54136-2213 Ph: (920) 364-9668 |
| NPI Number | 1225155393 |
|---|---|
| Provider Enumeration Date | 03/23/2007 |
| Last Update Date | 08/15/2022 |
| Certification Date | 08/15/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225155393 | NPI | - | NPPES |
| 43005000 | Medicaid | WI | |
| 42626 | Other | MN | HEALTH PARTNERS |
| 85575 | Other | MN | PREFERRED ONE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | 2160 (Wisconsin) | Primary |
Northwest Directions - Depere Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1119 W Kennedy Ave, Suite A, Kimberly, WI 54136 Phone: 920-364-9668 Fax: 888-625-8634 | |
Connections Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 569 Carter Ct, Kimberly, WI 54136 Phone: 920-450-0139 |