| Resilient Journey, Llc | |
|
13500 Watertown Plank Rd Ste 102 Elm Grove WI 53122-2222 | |
| (847) 340-5785 | |
| Not Available |
| Full Name | Resilient Journey, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 13500 Watertown Plank Rd Ste 102, Elm Grove, Wisconsin |
| Authorized Official Name and Position | Donald Roth (OWNER) |
| Authorized Official Contact | 8473405785 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Resilient Journey, Llc 2630 9th Ave South Milwaukee WI 53172-3216 Ph: (847) 340-5785 | Resilient Journey, Llc 13500 Watertown Plank Rd Ste 102 Elm Grove WI 53122-2222 Ph: (847) 340-5785 |
| NPI Number | 1649970757 |
|---|---|
| Provider Enumeration Date | 03/07/2023 |
| Last Update Date | 06/22/2023 |
| Certification Date | 06/22/2023 |
| Medicare PECOS PAC ID | 4688034614 |
|---|---|
| Medicare Enrollment ID | O20230721001293 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649970757 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | (* (Not Available)) | Secondary |
| Provider Name | Donald N Roth |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1336224989 PECOS PAC ID: 9537153416 Enrollment ID: I20230721001168 |
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