| Northwest Directions - Depere | |
|
1119 W Kennedy Ave Suite A Kimberly WI 54136-2213 | |
| (920) 364-9668 | |
| (888) 625-8634 |
| Full Name | Northwest Directions - Depere |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| 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 Directions - Depere Po Box 309 Siren WI 54872-0309 Ph: (715) 349-7069 | Northwest Directions - Depere 1119 W Kennedy Ave Suite A Kimberly WI 54136-2213 Ph: (920) 364-9668 |
| NPI Number | 1063721017 |
|---|---|
| Provider Enumeration Date | 09/24/2010 |
| Last Update Date | 08/15/2022 |
| Certification Date | 08/15/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063721017 | NPI | - | NPPES |
| 2924 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 2924 (Wisconsin) | Primary |
Northwest Journey-depere Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1119 W Kennedy Ave, Ste 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 |