| Kettle Moraine Counseling | |
|
400 W River Dr West Bend WI 53090-1567 | |
| (262) 334-4340 | |
| (262) 334-4341 |
| Full Name | Kettle Moraine Counseling |
|---|---|
| Speciality | Clinic/Center |
| Location | 400 W River Dr, West Bend, Wisconsin |
| Authorized Official Name and Position | Devona Lynn Marshall (OWNER/DIRECTOR) |
| Authorized Official Contact | 2623344340 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kettle Moraine Counseling 400 W River Dr West Bend WI 53090-1567 Ph: (262) 334-4340 | Kettle Moraine Counseling 400 W River Dr West Bend WI 53090-1567 Ph: (262) 334-4340 |
| NPI Number | 1568790954 |
|---|---|
| Provider Enumeration Date | 11/24/2009 |
| Last Update Date | 01/14/2020 |
| Certification Date | 01/14/2020 |
| Medicare PECOS PAC ID | 8527353747 |
|---|---|
| Medicare Enrollment ID | O20200416001123 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568790954 | NPI | - | NPPES |
| Provider Name | Catherine A Anderson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801884317 PECOS PAC ID: 3971510264 Enrollment ID: I20060310000514 |
| Provider Name | Marlene M Hetzel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164575015 PECOS PAC ID: 4981702438 Enrollment ID: I20070606000340 |
| Provider Name | Joellyn M Schultz |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1962555755 PECOS PAC ID: 7416943121 Enrollment ID: I20111130000107 |
| Provider Name | Elizabeth G Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417084559 PECOS PAC ID: 0941434047 Enrollment ID: I20131003000138 |
| Provider Name | Jaime Gunderson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164955878 PECOS PAC ID: 5092109652 Enrollment ID: I20220224000317 |
| Provider Name | Natalie Marie Eddy |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1770917957 PECOS PAC ID: 5092165712 Enrollment ID: I20231221000868 |
| Provider Name | Devona Lynn Marshall |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1740396241 PECOS PAC ID: 6800181025 Enrollment ID: I20231227001902 |
| Provider Name | Rebecca Whiting |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1194068346 PECOS PAC ID: 1456702869 Enrollment ID: I20240110003206 |
| Provider Name | Diane Schauble |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1093197170 PECOS PAC ID: 3173974409 Enrollment ID: I20240110004126 |
| Provider Name | Chandell Angelica Hintzke |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1396085759 PECOS PAC ID: 0244682359 Enrollment ID: I20240113000395 |
| Provider Name | Jennifer Skinner |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1063779700 PECOS PAC ID: 0547612509 Enrollment ID: I20240116002278 |
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