Professional Services Group | |
2108 63rd St Kenosha WI 53143-4454 | |
(262) 652-2406 | |
Not Available |
Full Name | Professional Services Group |
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Speciality | Social Worker |
Location | 2108 63rd St, Kenosha, Wisconsin |
Authorized Official Name and Position | Kerrie E Boeckman (CLINIC THERAPIST) |
Authorized Official Contact | 2626522406 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Professional Services Group 2108 63rd St Kenosha WI 53143-4454 Ph: (262) 652-2406 | Professional Services Group 2108 63rd St Kenosha WI 53143-4454 Ph: (262) 652-2406 |
NPI Number | 1386070134 |
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Provider Enumeration Date | 09/24/2013 |
Last Update Date | 09/24/2013 |
Identifier | Type | State | Issuer |
---|---|---|---|
1386070134 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
104100000X | Social Worker | 8047-123 (Wisconsin) | Primary |
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