| Full Name | |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 501 Park Ave, Oconto, Wisconsin |
| Authorized Official Name and Position | Scott Shackelford (DIRECTOR) |
| Authorized Official Contact | 9208347000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
501 Park Ave Oconto WI 54153-1612 Ph: (920) 834-7000 | 501 Park Ave Oconto WI 54153-1612 Ph: (920) 834-7000 |
| NPI Number | 1598848640 |
|---|---|
| Provider Enumeration Date | 10/23/2006 |
| Last Update Date | 08/01/2022 |
| Certification Date | 08/01/2022 |
| Medicare PECOS PAC ID | 4688835507 |
|---|---|
| Medicare Enrollment ID | O20120912000457 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598848640 | NPI | - | NPPES |
| 42140300 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Pamela M Page |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316272271 PECOS PAC ID: 9739220963 Enrollment ID: I20100109000076 |
| Provider Name | Kaitlyn M Villalpando |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1689195653 PECOS PAC ID: 6800246430 Enrollment ID: I20240311003689 |
Oconto County Health & Human Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 501 Park Ave, Oconto, WI 54153 Phone: 920-834-7000 Fax: 920-834-6889 | |