| Pathways Counseling Center Ii Llc | |
|
11121 W Oklahoma Ave West Allis WI 53227-4033 | |
| (262) 641-9790 | |
| (262) 641-9791 |
| Full Name | Pathways Counseling Center Ii Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 11121 W Oklahoma Ave, West Allis, Wisconsin |
| Authorized Official Name and Position | Ryan Stahl (BILLING SPECIALIST) |
| Authorized Official Contact | 2244265852 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pathways Counseling Center Ii Llc 11121 W Oklahoma Ave West Allis WI 53227-4033 Ph: (262) 641-9790 | Pathways Counseling Center Ii Llc 11121 W Oklahoma Ave West Allis WI 53227-4033 Ph: (262) 641-9790 |
| NPI Number | 1942490438 |
|---|---|
| Provider Enumeration Date | 07/31/2007 |
| Last Update Date | 02/25/2021 |
| Certification Date | 02/25/2021 |
| Medicare PECOS PAC ID | 7315970969 |
|---|---|
| Medicare Enrollment ID | O20050914000444 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942490438 | NPI | - | NPPES |
| 42227700 | Medicaid | WI |
| Provider Name | David John Bedrin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1801192893 PECOS PAC ID: 9739364605 Enrollment ID: I20110420000166 |
| Provider Name | Octavia Manuel-wright |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598950396 PECOS PAC ID: 6406129352 Enrollment ID: I20170829001736 |
| Provider Name | Tammy J King |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1851710909 PECOS PAC ID: 6406116987 Enrollment ID: I20180205000907 |
| Provider Name | Lynn Marie Dusold |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891836854 PECOS PAC ID: 0345561692 Enrollment ID: I20220429001327 |
| Provider Name | Kristen Roberts |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992287452 PECOS PAC ID: 6709273311 Enrollment ID: I20220429001416 |
| Provider Name | Roger Patrick Northway |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053449173 PECOS PAC ID: 8729011374 Enrollment ID: I20220531002418 |
| Provider Name | Kaitlin Cary-king |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073115366 PECOS PAC ID: 5193103638 Enrollment ID: I20220613000056 |
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