| Psych Med Management Llc | |
|
140 S Main St Thiensville WI 53092-1956 | |
| (262) 402-7964 | |
| (262) 261-5062 |
| Full Name | Psych Med Management Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 140 S Main St, Thiensville, Wisconsin |
| Authorized Official Name and Position | Therese Jaeckle (OWNER) |
| Authorized Official Contact | 4145301878 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Psych Med Management Llc 140 S Main St Thiensville WI 53092-1956 Ph: (262) 402-7964 | Psych Med Management Llc 140 S Main St Thiensville WI 53092-1956 Ph: (262) 402-7964 |
| NPI Number | 1376941963 |
|---|---|
| Provider Enumeration Date | 12/12/2014 |
| Last Update Date | 12/12/2014 |
| Medicare PECOS PAC ID | 5294053443 |
|---|---|
| Medicare Enrollment ID | O20150420000124 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376941963 | NPI | - | NPPES |
| 1063696516 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 3319-33 (Wisconsin) | Primary |
| Provider Name | Therese A Jaeckle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063696516 PECOS PAC ID: 1951480011 Enrollment ID: I20080501000134 |
| Provider Name | Susan Selthofner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356008668 PECOS PAC ID: 8426444860 Enrollment ID: I20220411002535 |
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