| Pathway Eclinic Sc | |
|
2300 N Mayfair Rd Suite 425 Wauwatosa WI 53226-1505 | |
| (414) 727-4455 | |
| (414) 727-4690 |
| Full Name | Pathway Eclinic Sc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 2300 N Mayfair Rd, Wauwatosa, Wisconsin |
| Authorized Official Name and Position | Tracey Lee Cornella- Carlson (PSYCHIATRIST) |
| Authorized Official Contact | 4147274455 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pathway Eclinic Sc 2300 N Mayfair Rd Suite 425 Wauwatosa WI 53226-1505 Ph: (414) 727-4455 | Pathway Eclinic Sc 2300 N Mayfair Rd Suite 425 Wauwatosa WI 53226-1505 Ph: (414) 727-4455 |
| NPI Number | 1679725352 |
|---|---|
| Provider Enumeration Date | 10/14/2008 |
| Last Update Date | 10/16/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679725352 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 2605 (Wisconsin) | Primary |
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