| Safe Harbor Health, Llc | |
|
706 Kenwood Cir Verona WI 53593-1017 | |
| (608) 845-2081 | |
| Not Available |
| Full Name | Safe Harbor Health, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 706 Kenwood Cir, Verona, Wisconsin |
| Authorized Official Name and Position | Jaclyn S Slesareva (OWNER, BEHAVIORAL HEALTH THERAPIST) |
| Authorized Official Contact | 6088452081 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Safe Harbor Health, Llc 706 Kenwood Cir Verona WI 53593-1017 Ph: (608) 845-2081 | Safe Harbor Health, Llc 706 Kenwood Cir Verona WI 53593-1017 Ph: (608) 845-2081 |
| NPI Number | 1861079816 |
|---|---|
| Provider Enumeration Date | 03/25/2021 |
| Last Update Date | 03/25/2021 |
| Certification Date | 03/25/2021 |
| Medicare PECOS PAC ID | 1052729159 |
|---|---|
| Medicare Enrollment ID | O20210408002010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861079816 | NPI | - | NPPES |
| 100093506 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Jaclyn Sue Slesareva |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1336616523 PECOS PAC ID: 2961810064 Enrollment ID: I20210408002071 |
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