| Northshore Clinic & Consultants, Inc. | |
|
W62n248 Washington Ave Suite #207 Cedarburg WI 53012-2768 | |
| (262) 375-1116 | |
| (262) 375-1071 |
| Full Name | Northshore Clinic & Consultants, Inc. |
|---|---|
| Speciality | Community/behavioral Health |
| Location | W62n248 Washington Ave, Cedarburg, Wisconsin |
| Authorized Official Name and Position | Therese A Jaeckle (CLINICAL DIRECTOR) |
| Authorized Official Contact | 2623751116 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Northshore Clinic & Consultants, Inc. W62n248 Washington Ave Suite #207 Cedarburg WI 53012-2768 Ph: (262) 375-1116 | Northshore Clinic & Consultants, Inc. W62n248 Washington Ave Suite #207 Cedarburg WI 53012-2768 Ph: (262) 375-1116 |
| NPI Number | 1720201163 |
|---|---|
| Provider Enumeration Date | 04/11/2007 |
| Last Update Date | 04/19/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720201163 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 1695 (Wisconsin) | Primary |
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