| Virago Wellness Initiative, Llc | |
|
W6240 Communication Ct Ste 2 Appleton WI 54914-8549 | |
| (920) 428-0580 | |
| Not Available |
| Full Name | Virago Wellness Initiative, Llc |
|---|---|
| Speciality | Psychologist |
| Location | W6240 Communication Ct Ste 2, Appleton, Wisconsin |
| Authorized Official Name and Position | Casey Hanson (PSYCHOLOGIST/OWNER) |
| Authorized Official Contact | 9204280580 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Virago Wellness Initiative, Llc W6240 Communication Ct Ste 2 Appleton WI 54914-8549 Ph: () - | Virago Wellness Initiative, Llc W6240 Communication Ct Ste 2 Appleton WI 54914-8549 Ph: (920) 428-0580 |
| NPI Number | 1285412411 |
|---|---|
| Provider Enumeration Date | 09/19/2023 |
| Last Update Date | 11/15/2023 |
| Certification Date | 11/15/2023 |
| Medicare PECOS PAC ID | 0749630853 |
|---|---|
| Medicare Enrollment ID | O20240102000604 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285412411 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Secondary |
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Casey Ann Hanson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1336331248 PECOS PAC ID: 9032268123 Enrollment ID: I20090520000279 |
| Provider Name | Traci L Brown |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1982830121 PECOS PAC ID: 6305283227 Enrollment ID: I20240327000513 |
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