| Intentional Psychology Llc | |
|
N14w23777 Stone Ridge Dr Ste 135 Waukesha WI 53188-1164 | |
| (414) 279-9082 | |
| (414) 501-4399 |
| Full Name | Intentional Psychology Llc |
|---|---|
| Speciality | Psychologist |
| Location | N14w23777 Stone Ridge Dr Ste 135, Waukesha, Wisconsin |
| Authorized Official Name and Position | Shanna R Thomsen (OWNER) |
| Authorized Official Contact | 4142799082 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Intentional Psychology Llc N14w23777 Stone Ridge Dr Ste 135 Waukesha WI 53188-1164 Ph: (414) 279-9082 | Intentional Psychology Llc N14w23777 Stone Ridge Dr Ste 135 Waukesha WI 53188-1164 Ph: (414) 279-9082 |
| NPI Number | 1699469411 |
|---|---|
| Provider Enumeration Date | 06/05/2023 |
| Last Update Date | 04/24/2026 |
| Certification Date | 04/24/2026 |
| Medicare PECOS PAC ID | 7416315247 |
|---|---|
| Medicare Enrollment ID | O20230626002994 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699469411 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Shanna Thomsen |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1417438250 PECOS PAC ID: 6204232531 Enrollment ID: I20210910002168 |
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