| Interconnections, Sc | |
|
920 60th St Kenosha WI 53140-4041 | |
| (262) 654-5333 | |
| (262) 654-7818 |
| Full Name | Interconnections, Sc |
|---|---|
| Speciality | Social Worker |
| Location | 920 60th St, Kenosha, Wisconsin |
| Authorized Official Name and Position | Sarah Nichols (CO-DIRECTOR) |
| Authorized Official Contact | 2626545333 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Interconnections, Sc 920 60th St Kenosha WI 53140-4041 Ph: (262) 654-5333 | Interconnections, Sc 920 60th St Kenosha WI 53140-4041 Ph: (262) 654-5333 |
| NPI Number | 1336214543 |
|---|---|
| Provider Enumeration Date | 11/22/2006 |
| Last Update Date | 11/08/2019 |
| Medicare PECOS PAC ID | 1052472586 |
|---|---|
| Medicare Enrollment ID | O20090323000008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336214543 | NPI | - | NPPES |
| 42133400 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 1440 (Wisconsin) | Primary |
| Provider Name | Herbert G Roehrich |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1811032378 PECOS PAC ID: 7810985215 Enrollment ID: I20040504001243 |
| Provider Name | Matthew Mccarthy |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1306917570 PECOS PAC ID: 9234122201 Enrollment ID: I20061220000163 |
| Provider Name | Donald A Walters |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417944216 PECOS PAC ID: 1658565262 Enrollment ID: I20101027001303 |
| Provider Name | Carrie J Leber |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891085320 PECOS PAC ID: 1658599568 Enrollment ID: I20140905000826 |
| Provider Name | Shauna K Richardson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447206511 PECOS PAC ID: 6103146956 Enrollment ID: I20150520000037 |
| Provider Name | Jena R Cluka |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1134508161 PECOS PAC ID: 6800155128 Enrollment ID: I20180112001460 |
| Provider Name | Sarah T Nichols |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1982077913 PECOS PAC ID: 9830408764 Enrollment ID: I20180509001533 |
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