| Dynamic Potential | |
|
316 5th St Ste 2 Racine WI 53403-4606 | |
| (262) 308-8085 | |
| Not Available |
| Full Name | Dynamic Potential |
|---|---|
| Speciality | Psychologist |
| Location | 316 5th St Ste 2, Racine, Wisconsin |
| Authorized Official Name and Position | Stephanie R Raszkiewicz (LICENSED PSYCHOLOGIST) |
| Authorized Official Contact | 2623088085 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dynamic Potential Po Box 1943 Kenosha WI 53141-1943 Ph: (262) 308-8085 | Dynamic Potential 316 5th St Ste 2 Racine WI 53403-4606 Ph: (262) 308-8085 |
| NPI Number | 1023656162 |
|---|---|
| Provider Enumeration Date | 12/19/2019 |
| Last Update Date | 02/24/2020 |
| Certification Date | 02/24/2020 |
| Medicare PECOS PAC ID | 4183051683 |
|---|---|
| Medicare Enrollment ID | O20200221002584 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023656162 | NPI | - | NPPES |
| 40968000 | Medicaid | WI |
| Provider Name | Stephanie Raszkiewicz |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1952577629 PECOS PAC ID: 2466608708 Enrollment ID: I20120802000093 |
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