| Gjb Health Services, Llc | |
|
711 N Lynndale Dr Ste 1a Appleton WI 54914-3078 | |
| (920) 560-4585 | |
| (920) 560-6618 |
| Full Name | Gjb Health Services, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 711 N Lynndale Dr Ste 1a, Appleton, Wisconsin |
| Authorized Official Name and Position | Gloria Jean Bannasch (OWNER ACCESS MANAGER) |
| Authorized Official Contact | 9202177861 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gjb Health Services, Llc 711 N Lynndale Dr Ste 1a Appleton WI 54914-3078 Ph: (920) 560-4525 | Gjb Health Services, Llc 711 N Lynndale Dr Ste 1a Appleton WI 54914-3078 Ph: (920) 560-4585 |
| NPI Number | 1659711687 |
|---|---|
| Provider Enumeration Date | 07/05/2013 |
| Last Update Date | 01/07/2022 |
| Certification Date | 01/07/2022 |
| Medicare PECOS PAC ID | 5496068405 |
|---|---|
| Medicare Enrollment ID | O20150721000083 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659711687 | NPI | - | NPPES |
| 100077381 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
| Provider Name | Gerald J Bannasch |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1528091030 PECOS PAC ID: 7810890233 Enrollment ID: I20040131000167 |
| Provider Name | Thomas J Zakrzewski |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194874511 PECOS PAC ID: 3779653852 Enrollment ID: I20080602000124 |
| Provider Name | Kevin K Klein |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417189135 PECOS PAC ID: 8123173606 Enrollment ID: I20090904000366 |
| Provider Name | Benjamin R Cheney |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1477727097 PECOS PAC ID: 9739316928 Enrollment ID: I20131213001224 |
| Provider Name | Jillian M Rotzenberg |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1336658285 PECOS PAC ID: 3476866484 Enrollment ID: I20240113000616 |
| Provider Name | Gloria Jean Bannasch |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1477876308 PECOS PAC ID: 2567775570 Enrollment ID: I20240215003305 |
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