| Sacred Wandering / Sacred Path Practitioners | |
|
10134 N Port Washington Rd Ste G Mequon WI 53092-5700 | |
| (414) 433-9193 | |
| (414) 435-9611 |
| Full Name | Sacred Wandering / Sacred Path Practitioners |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 10134 N Port Washington Rd Ste G, Mequon, Wisconsin |
| Authorized Official Name and Position | Kenneth J Nelan (OWNER/PROVIDER) |
| Authorized Official Contact | 4144339193 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Sacred Wandering / Sacred Path Practitioners 10134 N Port Washington Rd Ste G Mequon WI 53092-5700 Ph: (414) 433-9193 | Sacred Wandering / Sacred Path Practitioners 10134 N Port Washington Rd Ste G Mequon WI 53092-5700 Ph: (414) 433-9193 |
| NPI Number | 1780240614 |
|---|---|
| Provider Enumeration Date | 05/16/2019 |
| Last Update Date | 05/16/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780240614 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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