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1717 Center Ave Ste 420 Janesville WI 53546-2818 | |
| (608) 757-5025 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1717 Center Ave Ste 420, Janesville, Wisconsin |
| Authorized Official Name and Position | Jillian Bauer (BUSINESS SUPERVISOR) |
| Authorized Official Contact | 6087575152 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1717 Center Ave Ste 420 Janesville WI 53546-2818 Ph: (608) 757-5025 | 1717 Center Ave Ste 420 Janesville WI 53546-2818 Ph: (608) 757-5025 |
| NPI Number | 1700050416 |
|---|---|
| Provider Enumeration Date | 04/15/2008 |
| Last Update Date | 01/27/2025 |
| Certification Date | 01/27/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700050416 | NPI | - | NPPES |
| 42163100 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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