| South Street Clinic Llc | |
|
416 W South St Oconomowoc WI 53066-2755 | |
| (262) 567-7673 | |
| (262) 567-3097 |
| Full Name | South Street Clinic Llc |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 416 W South St, Oconomowoc, Wisconsin |
| Authorized Official Name and Position | Anne Alexa Weston (CLINIC OWNER) |
| Authorized Official Contact | 2625677673 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| South Street Clinic Llc 416 W South St Oconomowoc WI 53066-2755 Ph: (262) 567-7673 | South Street Clinic Llc 416 W South St Oconomowoc WI 53066-2755 Ph: (262) 567-7673 |
| NPI Number | 1235128356 |
|---|---|
| Provider Enumeration Date | 10/20/2005 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235128356 | NPI | - | NPPES |
| 42217900 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 1841 (Wisconsin) | Primary |
Ltdk Llc Elizabeth Turner Sole Mbr Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 405 E Forest St Ste 106, Oconomowoc, WI 53066 Phone: 920-988-1067 | |
Mark H Rossing Mdsc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 888 Thackeray Trl, Suite 211, Oconomowoc, WI 53066 Phone: 262-567-1122 Fax: 262-567-1481 | |
Joanne Berthelsen Lcsw Llc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 830 Armour Rd Ste 2, Oconomowoc, WI 53066 Phone: 262-235-2350 Fax: 235-804-8132 | |
Secure Beginnings, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: N52w35634 W Lake Dr, Oconomowoc, WI 53066 Phone: 262-901-5881 | |
A New Day Psychological Services Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 970 S Silver Lake St, Suite 103, Oconomowoc, WI 53066 Phone: 262-567-7900 Fax: 262-567-7908 | |
Bethany Christian Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1331 Capitol Dr, Oconomowoc, WI 53066 Phone: 262-547-6557 Fax: 262-547-3644 |