| Mommas Pedestal | |
|
2208 Skyline Dr West Bend WI 53090-1143 | |
| (414) 232-7277 | |
| Not Available |
| Full Name | Mommas Pedestal |
|---|---|
| Speciality | Psychologist |
| Location | 2208 Skyline Dr, West Bend, Wisconsin |
| Authorized Official Name and Position | Nicole Smith (OWNER) |
| Authorized Official Contact | 4142327277 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mommas Pedestal Po Box 434 Slinger WI 53086-0434 Ph: (414) 232-7277 | Mommas Pedestal 2208 Skyline Dr West Bend WI 53090-1143 Ph: (414) 232-7277 |
| NPI Number | 1033029491 |
|---|---|
| Provider Enumeration Date | 09/09/2026 |
| Last Update Date | 09/09/2026 |
| Certification Date | 09/09/2026 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033029491 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | () | Primary |
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