| Two Willows Counseling Llc | |
|
1414 Underwood Ave Ste 400 Wauwatosa WI 53213-2653 | |
| (414) 931-1278 | |
| Not Available |
| Full Name | Two Willows Counseling Llc |
|---|---|
| Speciality | Social Worker |
| Location | 1414 Underwood Ave Ste 400, Wauwatosa, Wisconsin |
| Authorized Official Name and Position | Sue Elizabeth Jennings (OWNER) |
| Authorized Official Contact | 4149311278 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Two Willows Counseling Llc 2115 N 117th St Wauwatosa WI 53226-2113 Ph: (141) 474-50214 | Two Willows Counseling Llc 1414 Underwood Ave Ste 400 Wauwatosa WI 53213-2653 Ph: (414) 931-1278 |
| NPI Number | 1922521186 |
|---|---|
| Provider Enumeration Date | 07/19/2017 |
| Last Update Date | 05/15/2024 |
| Certification Date | 05/15/2024 |
| Medicare PECOS PAC ID | 5092085175 |
|---|---|
| Medicare Enrollment ID | O20170721002783 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922521186 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 8136-123 (Wisconsin) | Primary |
| Provider Name | Sue E Jennings |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1508281668 PECOS PAC ID: 0143506568 Enrollment ID: I20170418002743 |
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