| Peace In Colorful Dynamics, Llc | |
|
516 E Wisconsin Ave Appleton WI 54911-4863 | |
| (920) 659-0078 | |
| (920) 843-9395 |
| Full Name | Peace In Colorful Dynamics, Llc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 516 E Wisconsin Ave, Appleton, Wisconsin |
| Authorized Official Name and Position | Samantha J Hanson (OWNER/PROVIDER) |
| Authorized Official Contact | 9206590078 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Peace In Colorful Dynamics, Llc 516 E Wisconsin Ave Appleton WI 54911-4863 Ph: (920) 659-0078 | Peace In Colorful Dynamics, Llc 516 E Wisconsin Ave Appleton WI 54911-4863 Ph: (920) 659-0078 |
| NPI Number | 1992319925 |
|---|---|
| Provider Enumeration Date | 09/08/2020 |
| Last Update Date | 10/03/2023 |
| Certification Date | 10/03/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992319925 | NPI | - | NPPES |
| 100040516 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
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