| Elmergreen Associates,llc | |
|
114 Grand Avenue Wausau WI 54403 | |
| (715) 845-7175 | |
| (715) 845-7142 |
| Full Name | Elmergreen Associates,llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 114 Grand Avenue, Wausau, Wisconsin |
| Authorized Official Name and Position | Dennis Dean Elmergreen (PSYCHOLOGIST/OWNER) |
| Authorized Official Contact | 7155517175 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Elmergreen Associates,llc 114 Grand Avenue Wausau WI 54403 Ph: (715) 845-7175 | Elmergreen Associates,llc 114 Grand Avenue Wausau WI 54403 Ph: (715) 845-7175 |
| NPI Number | 1922173418 |
|---|---|
| Provider Enumeration Date | 11/21/2006 |
| Last Update Date | 06/21/2023 |
| Certification Date | 06/21/2023 |
| Medicare PECOS PAC ID | 5496909483 |
|---|---|
| Medicare Enrollment ID | O20130128000409 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922173418 | NPI | - | NPPES |
| 42177800 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Dennis D Elmergreen |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1922172675 PECOS PAC ID: 7517863707 Enrollment ID: I20031209000607 |
| Provider Name | Douglas J Cybela |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1124178132 PECOS PAC ID: 0345291290 Enrollment ID: I20050208000614 |
| Provider Name | Jeffrey C Rothweiler |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1699894782 PECOS PAC ID: 3678757978 Enrollment ID: I20110412000092 |
| Provider Name | Kandace J Elmergreen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497874291 PECOS PAC ID: 0143587410 Enrollment ID: I20171128000359 |
| Provider Name | Courtney Christian Derus |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1255765335 PECOS PAC ID: 4284978347 Enrollment ID: I20181130002166 |
| Provider Name | David R Derus |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1295169381 PECOS PAC ID: 9032538749 Enrollment ID: I20200930000561 |
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