| Jodi Lorene Waddell, | |
|
124 Grayside Ave, Mauston, WI 53948-1913 | |
| (608) 847-7575 | |
| (608) 847-3096 |
| Full Name | Jodi Lorene Waddell |
|---|---|
| Gender | Female |
| Speciality | Mental Health Counselor |
| Experience | 4 Years |
| Location | 124 Grayside Ave, Mauston, Wisconsin |
| Accepts Medicare Assignments | May be. She may accept the Medicare-approved amount; you may be billed for more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972272755 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 12209-125 (Wisconsin) | Primary |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Pine Valley Integrated Services Llc | 2769777911 | 5 |
| Entity Name | Pine Valley Integrated Services LLC |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1013375104 PECOS PAC ID: 2769777911 Enrollment ID: O20160826000873 |
| Mailing Address | Practice Location Address |
|---|---|
| Jodi Lorene Waddell, S6908 Missel Rd, De Soto, WI 54624-6350 Ph: (608) 790-1967 | Jodi Lorene Waddell, 124 Grayside Ave, Mauston, WI 53948-1913 Ph: (608) 847-7575 |
Mr. Charles D Lipford, CSAC Counselor Medicare: Not Enrolled in Medicare Practice Location: 220 E La Crosse St., Juneau County Human Services, Mauston, WI 53948 Phone: 608-847-2400 Fax: 608-847-9599 |
Teresa Lynn Jacobson, MSW, LSW, CAPSW Counselor Medicare: Not Enrolled in Medicare Practice Location: 124 Grayside Ave, Mauston, WI 53948 Phone: 608-847-7575 Fax: 608-847-3096 |
Emma Brevik, Counselor Medicare: Not Enrolled in Medicare Practice Location: 512 Grayside Ave, Mauston, WI 53948 Phone: 608-847-1828 |
Ms. Cassandra A Heideman, LPC-IT, SAC-IT Counselor Medicare: Not Enrolled in Medicare Practice Location: 200 Hickory Street, Mauston, WI 53948 Phone: 608-847-2400 Fax: 608-847-9599 |
Crissy L Lobermier, Counselor Medicare: Not Enrolled in Medicare Practice Location: 124 Grayside Ave, Mauston, WI 53948 Phone: 608-847-7575 |
Katherine Andrews, MS, LPC Counselor Medicare: Accepting Medicare Assignments Practice Location: 200 S Hickory St, Mauston, WI 53948 Phone: 608-847-2400 Fax: 608-847-9599 |
Elisha Allen, LPC-IT Counselor Medicare: Not Enrolled in Medicare Practice Location: 522 Gateway Ave Ste F, Mauston, WI 53948 Phone: 608-377-3864 Fax: 608-716-3155 |