| Professional Services Group, Inc. | |
|
2108 63rd St Kenosha WI 53143-4454 | |
| (262) 652-2406 | |
| (262) 654-6960 |
| Full Name | Professional Services Group, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 2108 63rd St, Kenosha, Wisconsin |
| Authorized Official Name and Position | Jonathan Grapengieser (CLINICAL DIRECTOR) |
| Authorized Official Contact | 2626541004 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Professional Services Group, Inc. 6233 39th Ave Kenosha WI 53142-7015 Ph: (262) 654-1004 | Professional Services Group, Inc. 2108 63rd St Kenosha WI 53143-4454 Ph: (262) 652-2406 |
| NPI Number | 1619024262 |
|---|---|
| Provider Enumeration Date | 01/05/2007 |
| Last Update Date | 06/16/2022 |
| Certification Date | 06/16/2022 |
| Medicare PECOS PAC ID | 8224296454 |
|---|---|
| Medicare Enrollment ID | O20120220000742 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619024262 | NPI | - | NPPES |
| 42125700 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Shannon G O Brien |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1366529182 PECOS PAC ID: 9032010657 Enrollment ID: I20040116000553 |
| Provider Name | Lisa S Thill |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1841377694 PECOS PAC ID: 6800886664 Enrollment ID: I20040513001194 |
| Provider Name | Rosalyn Mcfarland |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821245028 PECOS PAC ID: 0547320962 Enrollment ID: I20081114000636 |
| Provider Name | Timothy J Schwaller |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1851542864 PECOS PAC ID: 5698933737 Enrollment ID: I20120221000866 |
| Provider Name | Brian A Wolf |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1609982040 PECOS PAC ID: 8426216680 Enrollment ID: I20120521000466 |
| Provider Name | Kemba M Banyard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295080521 PECOS PAC ID: 4587682331 Enrollment ID: I20120917000814 |
| Provider Name | Leah J Featherstone |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1558619379 PECOS PAC ID: 9032349550 Enrollment ID: I20140303000716 |
| Provider Name | Jonathan T Grapengieser |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1467703223 PECOS PAC ID: 1355565946 Enrollment ID: I20140623001523 |
| Provider Name | Kenya Renee Robertson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356629851 PECOS PAC ID: 6608098991 Enrollment ID: I20141121001136 |
| Provider Name | Jennifer L Brau |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1134591092 PECOS PAC ID: 8729377379 Enrollment ID: I20160520000616 |
| Provider Name | Annmarie K Ransom |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679959829 PECOS PAC ID: 3375852924 Enrollment ID: I20161110000510 |
| Provider Name | Karen S Lim |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316073836 PECOS PAC ID: 4981834447 Enrollment ID: I20161220001597 |
| Provider Name | Daniel Dashner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1144621376 PECOS PAC ID: 5698050573 Enrollment ID: I20170315001213 |
| Provider Name | Tierney Voit |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1396284683 PECOS PAC ID: 3870860141 Enrollment ID: I20170517002238 |
| Provider Name | Jennifer L Evancy |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1154486876 PECOS PAC ID: 9335417419 Enrollment ID: I20170613002719 |
| Provider Name | Dionna Lashaun Mcferrin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841746443 PECOS PAC ID: 4789956996 Enrollment ID: I20170823002408 |
| Provider Name | Octavia Manuel-wright |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598950396 PECOS PAC ID: 6406129352 Enrollment ID: I20170829001736 |
| Provider Name | Renee M Andreoli |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609388693 PECOS PAC ID: 2567720972 Enrollment ID: I20171212002435 |
| Provider Name | Leah D Keval |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1285037192 PECOS PAC ID: 8820353394 Enrollment ID: I20180604002073 |
| Provider Name | Amy Kuhagen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1326515321 PECOS PAC ID: 4981942513 Enrollment ID: I20190206002490 |
| Provider Name | Kimberly Berndt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083923049 PECOS PAC ID: 6901144880 Enrollment ID: I20190219002868 |
| Provider Name | Dana Ballewske |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1821345372 PECOS PAC ID: 1557601408 Enrollment ID: I20190313000471 |
| Provider Name | Amy Macdonald Wojcik |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669943874 PECOS PAC ID: 1850624925 Enrollment ID: I20190604001918 |
| Provider Name | Elizabeth Mundy-hemmerich |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1386834075 PECOS PAC ID: 2668795477 Enrollment ID: I20191220000177 |
| Provider Name | Deshawntae Griffin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649810938 PECOS PAC ID: 5395171995 Enrollment ID: I20200130000035 |
| Provider Name | Kathryn Koenig-leuck |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1679098743 PECOS PAC ID: 6507293818 Enrollment ID: I20200226002434 |
| Provider Name | Shalonda Myles |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659569929 PECOS PAC ID: 5092143750 Enrollment ID: I20200312001297 |
| Provider Name | Amanda Zalokar |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255877148 PECOS PAC ID: 9537599691 Enrollment ID: I20200414001724 |
| Provider Name | Kayla Stoltmann |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1124551627 PECOS PAC ID: 6103230636 Enrollment ID: I20210125002160 |
| Provider Name | Laura Jean Zellmer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457895658 PECOS PAC ID: 2163797986 Enrollment ID: I20210518002523 |
| Provider Name | Shanna Thomsen |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1417438250 PECOS PAC ID: 6204232531 Enrollment ID: I20210910002168 |
| Provider Name | Brittany Perez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1699269282 PECOS PAC ID: 5799183257 Enrollment ID: I20211013002965 |
| Provider Name | Elizabeth Gamboa-reynolds |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1689255291 PECOS PAC ID: 3971999616 Enrollment ID: I20220406001914 |
| Provider Name | Lauren Wuenstel |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053852129 PECOS PAC ID: 1951798198 Enrollment ID: I20220419000087 |
| Provider Name | Ellen Hanzalik-meo |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1801327077 PECOS PAC ID: 4183003403 Enrollment ID: I20220616001857 |
| Provider Name | Jennifer Conrardy |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1942936539 PECOS PAC ID: 6608251962 Enrollment ID: I20220922002036 |
| Provider Name | Alicia Livingston |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225583040 PECOS PAC ID: 4981080140 Enrollment ID: I20220926003594 |
| Provider Name | Brittany Gleason |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1720756273 PECOS PAC ID: 6406224831 Enrollment ID: I20221116001510 |
| Provider Name | Shakiyla Craft |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427696913 PECOS PAC ID: 2365810538 Enrollment ID: I20221118000693 |
| Provider Name | Sarah Vogt |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992220727 PECOS PAC ID: 6002280088 Enrollment ID: I20230314001382 |
| Provider Name | Kristin Dillow |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922683598 PECOS PAC ID: 0143694000 Enrollment ID: I20230316002016 |
| Provider Name | Jeremy L Kaup |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649970773 PECOS PAC ID: 8224493911 Enrollment ID: I20230502002758 |
| Provider Name | Rachel C Vande Hei |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1376120279 PECOS PAC ID: 6709245350 Enrollment ID: I20230629003822 |
| Provider Name | Angela Dellise |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1164718151 PECOS PAC ID: 2163874819 Enrollment ID: I20240117004662 |
| Provider Name | Angela J Kuffel |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1053787788 PECOS PAC ID: 1951753359 Enrollment ID: I20240122003068 |
| Provider Name | Angela Langenfeld |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1326598921 PECOS PAC ID: 1759734957 Enrollment ID: I20240124001227 |
| Provider Name | Dana Robinson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1598434870 PECOS PAC ID: 9931552148 Enrollment ID: I20240124001576 |
| Provider Name | Heather Cooper |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1568058238 PECOS PAC ID: 8729421672 Enrollment ID: I20240207002179 |
| Provider Name | Jennifer Marie Dahlke |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1518447754 PECOS PAC ID: 4082057724 Enrollment ID: I20240208004357 |
| Provider Name | Dawn Miller-duval |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1417484155 PECOS PAC ID: 9133562853 Enrollment ID: I20240209002373 |
| Provider Name | Kerah Mae Modesti |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1477133510 PECOS PAC ID: 7719320167 Enrollment ID: I20240213001956 |
| Provider Name | Michelle M. Runnion |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1912117318 PECOS PAC ID: 1153589312 Enrollment ID: I20240214001888 |
| Provider Name | Jessica Martzahl |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1033685474 PECOS PAC ID: 3971947003 Enrollment ID: I20240216002724 |
| Provider Name | Susanne Smith |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1194322065 PECOS PAC ID: 6608210521 Enrollment ID: I20240220000834 |
| Provider Name | Sara N Jettawi |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1447912480 PECOS PAC ID: 2567806250 Enrollment ID: I20240221002602 |
| Provider Name | Magdalene Helene Danzer-malinowski |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1003586587 PECOS PAC ID: 2860836459 Enrollment ID: I20240222001999 |
| Provider Name | Sierra Worob |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1568031284 PECOS PAC ID: 4082058680 Enrollment ID: I20240222002520 |
| Provider Name | Latrice Marshall |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1336703750 PECOS PAC ID: 3476997917 Enrollment ID: I20240222003822 |
| Provider Name | Nataly Aguirre |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1972085181 PECOS PAC ID: 5799120218 Enrollment ID: I20240223002948 |
| Provider Name | Marjorie Y Mendoza |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1124324090 PECOS PAC ID: 8123463437 Enrollment ID: I20240227000821 |
| Provider Name | Anna J Holland |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1871937789 PECOS PAC ID: 2769828375 Enrollment ID: I20240306000455 |
| Provider Name | Autumn Marzette-anderson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1689346207 PECOS PAC ID: 5294171773 Enrollment ID: I20240306003258 |
| Provider Name | Nicole Ann Lensmire |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1528660990 PECOS PAC ID: 4880031533 Enrollment ID: I20240318002503 |
| Provider Name | Daysi Jimenez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427773266 PECOS PAC ID: 7719329747 Enrollment ID: I20240522003087 |
Calming Waves Therapy, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 2901 35th St, Kenosha, WI 53140 Phone: 815-904-0185 | |
Neuropsychological Consultants Inc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 5017 Green Bay Rd Ste 130, Kenosha, WI 53144 Phone: 262-671-1334 | |
Clearview Counseling Group Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 10900 67th St, Kenosha, WI 53142 Phone: 262-914-7422 | |
Kenosha County Department Of Human Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 8600 Sheridan Road, Suite 100, Kenosha, WI 53143 Phone: 262-605-6524 Fax: 262-697-4655 | |
Journey House International Center Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 8032 22nd Ave # 5151, Kenosha, WI 53143 Phone: 262-289-4378 Fax: 262-288-4353 | |
Be Insightful Counseling Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 2901 35th St Lowr Suiteb, Kenosha, WI 53140 Phone: 262-764-2459 | |
Kenosha County Department Of Human Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 8600 Sheridan Road, Suite 100, Kenosha, WI 53143 Phone: 262-605-6524 Fax: 262-697-4655 |