| Kenosha Human Development Services, Inc | |
|
3536 52nd St Kenosha WI 53144-2662 | |
| (262) 842-0538 | |
| (262) 842-0539 |
| Full Name | Kenosha Human Development Services, Inc |
|---|---|
| Speciality | Case Management |
| Location | 3536 52nd St, Kenosha, Wisconsin |
| Authorized Official Name and Position | Jeannine Marie Field (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 2627648555 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kenosha Human Development Services, Inc 3536 52nd St Kenosha WI 53144-2662 Ph: (262) 842-0538 | Kenosha Human Development Services, Inc 3536 52nd St Kenosha WI 53144-2662 Ph: (262) 842-0538 |
| NPI Number | 1942470661 |
|---|---|
| Provider Enumeration Date | 03/10/2008 |
| Last Update Date | 09/06/2022 |
| Certification Date | 09/06/2022 |
| Medicare PECOS PAC ID | 0143467720 |
|---|---|
| Medicare Enrollment ID | O20130520000465 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942470661 | NPI | - | NPPES |
| 32975970 | Medicaid | WI |
| Provider Name | Matthew Mccarthy |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1306917570 PECOS PAC ID: 9234122201 Enrollment ID: I20061220000163 |
| Provider Name | Vicki L Smith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265870323 PECOS PAC ID: 4082905179 Enrollment ID: I20160621000852 |
| Provider Name | Kristen A Palmer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811500358 PECOS PAC ID: 7012322712 Enrollment ID: I20210210001298 |
| Provider Name | Eunice Boatin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225641392 PECOS PAC ID: 9537574298 Enrollment ID: I20210211000811 |
| Provider Name | Sherilyn Catherine Klamm |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619154994 PECOS PAC ID: 1254703192 Enrollment ID: I20230202001524 |
| Provider Name | La Shanda Tolefree |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1003350422 PECOS PAC ID: 1951774405 Enrollment ID: I20240603001987 |
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