| New Wellness Associates | |
|
2733 S Ridge Rd Green Bay WI 54304-5513 | |
| (920) 497-6200 | |
| (920) 497-3135 |
| Full Name | New Wellness Associates |
|---|---|
| Speciality | Counselor |
| Location | 2733 S Ridge Rd, Green Bay, Wisconsin |
| Authorized Official Name and Position | Joann M Berken (OFFICE MANAGER) |
| Authorized Official Contact | 9204976200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| New Wellness Associates 2733 S Ridge Rd Green Bay WI 54304-5513 Ph: (920) 497-6200 | New Wellness Associates 2733 S Ridge Rd Green Bay WI 54304-5513 Ph: (920) 497-6200 |
| NPI Number | 1275650673 |
|---|---|
| Provider Enumeration Date | 03/23/2007 |
| Last Update Date | 01/17/2008 |
| Medicare PECOS PAC ID | 7113008012 |
|---|---|
| Medicare Enrollment ID | O20080117000019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275650673 | NPI | - | NPPES |
| 42174300 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 1669 (Wisconsin) | Primary |
| Provider Name | Diane M Moga Roach |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1700923471 PECOS PAC ID: 3476634379 Enrollment ID: I20210105002542 |
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