| Ravenswood Clinic | |
|
2266 N Prospect Ave Suite 608 Milwaukee WI 53202-6306 | |
| (414) 224-0492 | |
| (414) 224-8112 |
| Full Name | Ravenswood Clinic |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 2266 N Prospect Ave, Milwaukee, Wisconsin |
| Authorized Official Name and Position | Anthony Francis Werth (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 4142240492 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ravenswood Clinic 2266 N Prospect Ave Suite 326 Milwaukee WI 53202-6306 Ph: (414) 224-0492 | Ravenswood Clinic 2266 N Prospect Ave Suite 608 Milwaukee WI 53202-6306 Ph: (414) 224-0492 |
| NPI Number | 1285716308 |
|---|---|
| Provider Enumeration Date | 10/19/2006 |
| Last Update Date | 03/27/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285716308 | NPI | - | NPPES |
| L12215600 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 2118 (Wisconsin) | Primary |
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