| Nspa | |
|
5555 N Port Washington Rd Ste 300 Glendale WI 53217-4928 | |
| (414) 962-6764 | |
| (414) 962-6765 |
| Full Name | Nspa |
|---|---|
| Speciality | Clinic/Center |
| Location | 5555 N Port Washington Rd Ste 300, Glendale, Wisconsin |
| Authorized Official Name and Position | Sheryl Dolezal (CO DIRECTOR) |
| Authorized Official Contact | 4149626764 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Nspa 5555 N Port Washington Rd Ste 300 Glendale WI 53217-4928 Ph: (414) 962-6764 | Nspa 5555 N Port Washington Rd Ste 300 Glendale WI 53217-4928 Ph: (414) 962-6764 |
| NPI Number | 1194809574 |
|---|---|
| Provider Enumeration Date | 10/24/2006 |
| Last Update Date | 05/08/2023 |
| Certification Date | 05/08/2023 |
| Medicare PECOS PAC ID | 4688737646 |
|---|---|
| Medicare Enrollment ID | O20090116000521 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194809574 | NPI | - | NPPES |
| 100047128 | Medicaid | WI | |
| K100345509 | Other | WI | MEDICARE |
| Provider Name | Patricia M Meyer Chan |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1215015193 PECOS PAC ID: 9032272711 Enrollment ID: I20090106000692 |
| Provider Name | Sheryl L Dolezal |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1497839872 PECOS PAC ID: 7911914981 Enrollment ID: I20090121000473 |
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