| Crossing The Bridges | |
|
840 Challenger Dr Ste 130 Green Bay WI 54311-8351 | |
| (920) 712-4526 | |
| (800) 469-0235 |
| Full Name | Crossing The Bridges |
|---|---|
| Speciality | Social Worker |
| Location | 840 Challenger Dr Ste 130, Green Bay, Wisconsin |
| Authorized Official Name and Position | Lois A Pulvermacher (OWNER) |
| Authorized Official Contact | 9207124526 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Crossing The Bridges 101 Primrose Ln Green Bay WI 54311-6882 Ph: (920) 712-4526 | Crossing The Bridges 840 Challenger Dr Ste 130 Green Bay WI 54311-8351 Ph: (920) 712-4526 |
| NPI Number | 1790230589 |
|---|---|
| Provider Enumeration Date | 08/22/2016 |
| Last Update Date | 06/01/2020 |
| Certification Date | 06/01/2020 |
| Medicare PECOS PAC ID | 0345535894 |
|---|---|
| Medicare Enrollment ID | O20160823000376 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790230589 | NPI | - | NPPES |
| 40918400 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | LCSW 7302-123 (Wisconsin) | Primary |
| Provider Name | Lois A Pulvermacher |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215078662 PECOS PAC ID: 4486831963 Enrollment ID: I20110609000485 |
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