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W6144 Aerotech Dr Appleton WI 54914-7503 | |
| (704) 506-6267 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Psychologist |
| Location | W6144 Aerotech Dr, Appleton, Wisconsin |
| Authorized Official Name and Position | Leslie Johnson (CEO) |
| Authorized Official Contact | 7045066267 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
11000 Optum Cir Eden Prairie MN 55344-2503 Ph: (704) 506-6267 | W6144 Aerotech Dr Appleton WI 54914-7503 Ph: (704) 506-6267 |
| NPI Number | 1487424826 |
|---|---|
| Provider Enumeration Date | 01/08/2024 |
| Last Update Date | 04/24/2024 |
| Certification Date | 04/24/2024 |
| Medicare PECOS PAC ID | 0941648463 |
|---|---|
| Medicare Enrollment ID | O20240429000918 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487424826 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC1900X | Psychologist - Counseling | (* (Not Available)) | Primary |
| Provider Name | Kristen J Henke |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1750411930 PECOS PAC ID: 8325205024 Enrollment ID: I20120208000493 |
| Provider Name | Damon R Camarata |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1508127465 PECOS PAC ID: 7810151065 Enrollment ID: I20120619000576 |
| Provider Name | Ashley Elizabeth Birkholz |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1003271693 PECOS PAC ID: 0446595052 Enrollment ID: I20181228001403 |
| Provider Name | Laurie Ann Rechek |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1144757394 PECOS PAC ID: 1658701719 Enrollment ID: I20200414001543 |
| Provider Name | Dana S Lehrer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548886567 PECOS PAC ID: 0749605285 Enrollment ID: I20200731000505 |
| Provider Name | Sharon Ann Teschke |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1487868139 PECOS PAC ID: 3577970813 Enrollment ID: I20210401002020 |
| Provider Name | Stephanie Jean Crane |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1851025985 PECOS PAC ID: 5496120966 Enrollment ID: I20230414001883 |
| Provider Name | Brenda Jones |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1386658979 PECOS PAC ID: 2668473448 Enrollment ID: I20230724002454 |
| Provider Name | Megan Bednarczyk |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1164871380 PECOS PAC ID: 7719330760 Enrollment ID: I20240126000702 |
| Provider Name | Judy Wang Lue Bertoni |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1215073747 PECOS PAC ID: 3274976006 Enrollment ID: I20240208003858 |
| Provider Name | Kristine Kay Sack |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1215291950 PECOS PAC ID: 6800320912 Enrollment ID: I20241112004169 |
| Provider Name | Christopher L Stanaszak |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1114095148 PECOS PAC ID: 7810423654 Enrollment ID: I20241204000847 |
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