Jessica Young, LPC, CMHIMP | |
129 Kenosha St, Walworth, WI 53184 | |
(262) 607-2770 | |
Not Available |
Full Name | Jessica Young |
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Gender | Female |
Speciality | Counselor - Professional |
Location | 129 Kenosha St, Walworth, Wisconsin |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1902200108 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YP2500X | Counselor - Professional | 5479-125 (Wisconsin) | Primary |
Entity Name | Center For Change, Llc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1720511330 PECOS PAC ID: 9830534551 Enrollment ID: O20240304001640 |
Mailing Address | Practice Location Address |
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Jessica Young, LPC, CMHIMP Po Box 252, Walworth, WI 53184 Ph: (262) 607-2770 | Jessica Young, LPC, CMHIMP 129 Kenosha St, Walworth, WI 53184 Ph: (262) 607-2770 |
Krysta Zarnstorff, Counselor Medicare: Not Enrolled in Medicare Practice Location: 129 Kenosha St, Walworth, WI 53184 Phone: 262-607-2770 | |
Isabelle Wangerin, Counselor Medicare: Not Enrolled in Medicare Practice Location: 129 Kenosha St, Walworth, WI 53184 Phone: 262-607-2770 | |
Mr. Daniel William Rankin, Counselor Medicare: Not Enrolled in Medicare Practice Location: 129 Kenosha St, Walworth, WI 53184 Phone: 262-607-2770 |