| Jessie Crawford Recovery Center | |
|
131 Clarmar Dr Sun Prairie WI 53590-2664 | |
| (608) 318-0932 | |
| Not Available |
| Full Name | Jessie Crawford Recovery Center |
|---|---|
| Speciality | Counselor |
| Location | 131 Clarmar Dr, Sun Prairie, Wisconsin |
| Authorized Official Name and Position | Samantha Labonte (ADMIN) |
| Authorized Official Contact | 4148584141 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jessie Crawford Recovery Center 6400 Industrial Loop Greendale WI 53129-2452 Ph: (414) 858-4141 | Jessie Crawford Recovery Center 131 Clarmar Dr Sun Prairie WI 53590-2664 Ph: (608) 318-0932 |
| NPI Number | 1124372586 |
|---|---|
| Provider Enumeration Date | 11/06/2012 |
| Last Update Date | 07/14/2025 |
| Certification Date | 07/14/2025 |
| Medicare PECOS PAC ID | 4981971116 |
|---|---|
| Medicare Enrollment ID | O20170518001954 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124372586 | NPI | - | NPPES |
| 1124372586 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
| Provider Name | Nick S Yackovich |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1497909733 PECOS PAC ID: 2567766629 Enrollment ID: I20160210000633 |
| Provider Name | Joseph Nathan Blustein |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1164427738 PECOS PAC ID: 2961598594 Enrollment ID: I20170925001856 |
| Provider Name | Patrice N Mcbeath |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1043735129 PECOS PAC ID: 7315472917 Enrollment ID: I20241119003790 |
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