| Power For Change, Llc | |
|
123 N Oakland Ave Green Bay WI 54303-2831 | |
| (920) 770-4088 | |
| (920) 496-7922 |
| Full Name | Power For Change, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 123 N Oakland Ave, Green Bay, Wisconsin |
| Authorized Official Name and Position | Steve Anthony Shefchik (CLINICAL DIRECTOR) |
| Authorized Official Contact | 9207704088 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Power For Change, Llc 123 N Oakland Ave Green Bay WI 54303-2831 Ph: (920) 770-4088 | Power For Change, Llc 123 N Oakland Ave Green Bay WI 54303-2831 Ph: (920) 770-4088 |
| NPI Number | 1124322284 |
|---|---|
| Provider Enumeration Date | 01/04/2011 |
| Last Update Date | 11/16/2021 |
| Certification Date | 11/16/2021 |
| Medicare PECOS PAC ID | 0840571253 |
|---|---|
| Medicare Enrollment ID | O20161223000022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124322284 | NPI | - | NPPES |
| 100013205 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Vanessa Blanchette |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1063834612 PECOS PAC ID: 2062703523 Enrollment ID: I20160614001789 |
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