| Tammy Breault, | |
|
2367 Beede Lake Trl, Saint Croix Falls, WI 54024-7931 | |
| (715) 553-0159 | |
| Not Available |
| Full Name | Tammy Breault |
|---|---|
| Gender | Female |
| Speciality | Counselor - Professional |
| Location | 2367 Beede Lake Trl, Saint Croix Falls, Wisconsin |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902207012 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 6219-125 (Wisconsin) | Primary |
| Entity Name | Mental Health Specialty Group Pa |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1801472634 PECOS PAC ID: 8921466228 Enrollment ID: O20240729000310 |
| Mailing Address | Practice Location Address |
|---|---|
| Tammy Breault, 2367 Beede Lake Trl, Saint Croix Falls, WI 54024-7931 Ph: (715) 553-0159 | Tammy Breault, 2367 Beede Lake Trl, Saint Croix Falls, WI 54024-7931 Ph: (715) 553-0159 |
Marcelle N Dodge, LCSW, CSAC Counselor Medicare: Accepting Medicare Assignments Practice Location: 235 E State St, Saint Croix Falls, WI 54024 Phone: 715-483-3221 Fax: 715-483-0507 | |
Melanie Lynn Creger, MA, LPC, CSAC Counselor Medicare: Not Enrolled in Medicare Practice Location: 235 E State St, Saint Croix Falls, WI 54024 Phone: 715-483-3221 Fax: 715-483-0507 | |
Stephanie A Wilson, MS,CSW, LPC Counselor Medicare: Medicare Enrolled Practice Location: 520 S Washington St, Suite 110, Saint Croix Falls, WI 54024 Phone: 715-246-4840 Fax: 715-246-4108 | |
Abigail Kathleen Peterson, Counselor Medicare: Not Enrolled in Medicare Practice Location: 102 N Washington St, Saint Croix Falls, WI 54024 Phone: 716-961-1055 | |
Kristie Lervick, LADC Counselor Medicare: Not Enrolled in Medicare Practice Location: 1 St Croix Lofts Dr, 101, Saint Croix Falls, WI 54024 Phone: 952-836-5473 | |
Penny Lynn Bearheart, LPC, SAC Counselor Medicare: Medicare Enrolled Practice Location: 235 E State St, Saint Croix Falls, WI 54024 Phone: 715-483-3221 Fax: 715-483-0507 |