Russ Kinkade, Psy.d., S.c. | |
6214 Washington Ave C-10 Mount Pleasant WI 53406-3986 | |
(262) 989-5228 | |
(262) 878-9285 |
Full Name | Russ Kinkade, Psy.d., S.c. |
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Speciality | Clinic/Center |
Location | 6214 Washington Ave, Mount Pleasant, Wisconsin |
Authorized Official Name and Position | Russell William Kinkade (PRESIDENT) |
Authorized Official Contact | 2629895228 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Russ Kinkade, Psy.d., S.c. S55w29307 Holiday Point Dr Waukesha WI 53189-9026 Ph: (262) 989-5228 | Russ Kinkade, Psy.d., S.c. 6214 Washington Ave C-10 Mount Pleasant WI 53406-3986 Ph: (262) 989-5228 |
NPI Number | 1992195192 |
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Provider Enumeration Date | 01/27/2015 |
Last Update Date | 06/02/2023 |
Medicare PECOS PAC ID | 8921327644 |
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Medicare Enrollment ID | O20150430002606 |
Identifier | Type | State | Issuer |
---|---|---|---|
1992195192 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | 1296 (Wisconsin) | Primary |
261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Secondary |
Provider Name | Russell Kinkade |
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Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1033295571 PECOS PAC ID: 0446437602 Enrollment ID: I20150824001097 |
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