| Midway Clinical Neuropsychologic Institute And Children's Wellness Fou | |
|
1024 60th Street Suite 5 Kenosha WI 53140-4099 | |
| (262) 455-2919 | |
| (262) 455-2919 |
| Full Name | Midway Clinical Neuropsychologic Institute And Children's Wellness Fou |
|---|---|
| Speciality | Psychologist |
| Location | 1024 60th Street, Kenosha, Wisconsin |
| Authorized Official Name and Position | Shellie D. Locke (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 2624552919 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Midway Clinical Neuropsychologic Institute And Children's Wellness Fou P.o. Box 684 Kenosha WI 53141-0684 Ph: (262) 455-2919 | Midway Clinical Neuropsychologic Institute And Children's Wellness Fou 1024 60th Street Suite 5 Kenosha WI 53140-4099 Ph: (262) 455-2919 |
| NPI Number | 1578023156 |
|---|---|
| Provider Enumeration Date | 03/21/2019 |
| Last Update Date | 03/21/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578023156 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103G00000X | Clinical Neuropsychologist | (* (Not Available)) | Secondary |
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
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