| Waushara County | |
|
380 S Townline Rd Wautoma WI 54982-6900 | |
| (207) 876-5509 | |
| Not Available |
| Full Name | Waushara County |
|---|---|
| Speciality | Clinic/Center |
| Location | 380 S Townline Rd, Wautoma, Wisconsin |
| Authorized Official Name and Position | Jen Gonzales (ACCOUNT CLERK) |
| Authorized Official Contact | 9207876550 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Waushara County 380 S Townline Rd Wautoma WI 54982-6900 Ph: (920) 787-6550 | Waushara County 380 S Townline Rd Wautoma WI 54982-6900 Ph: (207) 876-5509 |
| NPI Number | 1932207362 |
|---|---|
| Provider Enumeration Date | 09/20/2006 |
| Last Update Date | 11/07/2024 |
| Certification Date | 11/07/2024 |
| Medicare PECOS PAC ID | 9638071681 |
|---|---|
| Medicare Enrollment ID | O20040121001042 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932207362 | NPI | - | NPPES |
| 42140600 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Jennifer A Ward |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114205481 PECOS PAC ID: 7618131574 Enrollment ID: I20120606000298 |
| Provider Name | Sonea Mahboob |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1790063402 PECOS PAC ID: 0244523645 Enrollment ID: I20190306000555 |
| Provider Name | Laurinda Wittenhagen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023466554 PECOS PAC ID: 3779996905 Enrollment ID: I20210107002807 |
| Provider Name | Clara L Voigtlander |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760947881 PECOS PAC ID: 0648686360 Enrollment ID: I20210304000470 |
| Provider Name | Alexia Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659569002 PECOS PAC ID: 7911154034 Enrollment ID: I20220201000387 |
Waushara County Crisis Intervention Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 230 W Park Street, Wautoma, WI 54982 Phone: 920-787-6550 Fax: 920-787-0421 | |
Waushara County Crisis Intervention Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 380 S Townline Rd, Wautoma, WI 54982 Phone: 920-787-6550 Fax: 920-787-0421 | |
Waushara County Clinical Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 230 Park St, Wautoma, WI 54982 Phone: 920-787-6550 Fax: 920-787-0421 |