| Neurowave Therapy Group Llc | |
|
5910 39th Ave Kenosha WI 53144-2738 | |
| (262) 833-5999 | |
| (262) 357-8431 |
| Full Name | Neurowave Therapy Group Llc |
|---|---|
| Speciality | Counselor |
| Location | 5910 39th Ave, Kenosha, Wisconsin |
| Authorized Official Name and Position | Miriam E Corona (OWNER) |
| Authorized Official Contact | 2624478999 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Neurowave Therapy Group Llc 1920 90th St Sturtevant WI 53177-1806 Ph: (262) 833-5999 | Neurowave Therapy Group Llc 5910 39th Ave Kenosha WI 53144-2738 Ph: (262) 833-5999 |
| NPI Number | 1205660206 |
|---|---|
| Provider Enumeration Date | 08/30/2024 |
| Last Update Date | 04/03/2025 |
| Certification Date | 04/03/2025 |
| Medicare PECOS PAC ID | 2365976396 |
|---|---|
| Medicare Enrollment ID | O20241113000913 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205660206 | NPI | - | NPPES |
| 1649745340 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Miriam E Corona |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1649745340 PECOS PAC ID: 3274067202 Enrollment ID: I20241113001736 |
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