| Midwest Wellness Inc. | |
|
715 Decorah Rd West Bend WI 53095-8112 | |
| (262) 305-9668 | |
| Not Available |
| Full Name | Midwest Wellness Inc. |
|---|---|
| Speciality | Counselor |
| Location | 715 Decorah Rd, West Bend, Wisconsin |
| Authorized Official Name and Position | Lynn M Nowak (OWNER) |
| Authorized Official Contact | 2623059668 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Midwest Wellness Inc. 715 Decorah Rd West Bend WI 53095-8112 Ph: (262) 305-9668 | Midwest Wellness Inc. 715 Decorah Rd West Bend WI 53095-8112 Ph: (262) 305-9668 |
| NPI Number | 1427834654 |
|---|---|
| Provider Enumeration Date | 09/05/2023 |
| Last Update Date | 06/06/2024 |
| Certification Date | 06/06/2024 |
| Medicare PECOS PAC ID | 1557702537 |
|---|---|
| Medicare Enrollment ID | O20240508000883 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427834654 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Lynn Gillian-nowak |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1962748624 PECOS PAC ID: 1850702291 Enrollment ID: I20240508001430 |
| Provider Name | Casey-ann R Dohse |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1669035101 PECOS PAC ID: 4284166745 Enrollment ID: I20241022002888 |
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