| Terri O'donnell Lpc Sasa Llc | |
|
802 W Broadway Suite 206 Monona WI 53713-1821 | |
| (608) 347-5015 | |
| Not Available |
| Full Name | Terri O'donnell Lpc Sasa Llc |
|---|---|
| Speciality | Counselor |
| Location | 802 W Broadway, Monona, Wisconsin |
| Authorized Official Name and Position | Teresa Anne O'donnell (OWNER) |
| Authorized Official Contact | 6083475015 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Terri O'donnell Lpc Sasa Llc 2828 Nashua Ln Cottage Grove WI 53527-9551 Ph: (608) 347-5015 | Terri O'donnell Lpc Sasa Llc 802 W Broadway Suite 206 Monona WI 53713-1821 Ph: (608) 347-5015 |
| NPI Number | 1356630040 |
|---|---|
| Provider Enumeration Date | 04/03/2011 |
| Last Update Date | 04/03/2011 |
| Medicare PECOS PAC ID | 2769822105 |
|---|---|
| Medicare Enrollment ID | O20240501003858 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356630040 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 4013-125 (Wisconsin) | Primary |
| Provider Name | Teresa Anne O'donnell |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1104158575 PECOS PAC ID: 3678913019 Enrollment ID: I20240501003915 |
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