| Edelweiss Behavioral Health Llc | |
|
6402 Odana Rd Madison WI 53719-1123 | |
| (608) 695-0674 | |
| Not Available |
| Full Name | Edelweiss Behavioral Health Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 6402 Odana Rd, Madison, Wisconsin |
| Authorized Official Name and Position | Anna Aufderhaar (OWNER/LPC) |
| Authorized Official Contact | 6086950674 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Edelweiss Behavioral Health Llc 6402 Odana Rd Madison WI 53719-1123 Ph: (608) 695-0674 | Edelweiss Behavioral Health Llc 6402 Odana Rd Madison WI 53719-1123 Ph: (608) 695-0674 |
| NPI Number | 1194128785 |
|---|---|
| Provider Enumeration Date | 09/27/2014 |
| Last Update Date | 09/27/2014 |
| Medicare PECOS PAC ID | 6709308059 |
|---|---|
| Medicare Enrollment ID | O20250317002453 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194128785 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | E045838 (Wisconsin) | Primary |
| Provider Name | Alicia Towne Ellison |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346609914 PECOS PAC ID: 0446582365 Enrollment ID: I20191025002550 |
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