| Russ Kinkade, Psy.d., S.c. | |
|
6214 Washington Ave C-10 Mount Pleasant WI 53406-3986 | |
| (262) 989-5228 | |
| (262) 878-9285 |
| Full Name | Russ Kinkade, Psy.d., S.c. |
|---|---|
| Speciality | Clinic/Center |
| Location | 6214 Washington Ave, Mount Pleasant, Wisconsin |
| Authorized Official Name and Position | Russell William Kinkade (PRESIDENT) |
| Authorized Official Contact | 2629895228 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Russ Kinkade, Psy.d., S.c. S55w29307 Holiday Point Dr Waukesha WI 53189-9026 Ph: (262) 989-5228 | Russ Kinkade, Psy.d., S.c. 6214 Washington Ave C-10 Mount Pleasant WI 53406-3986 Ph: (262) 989-5228 |
| NPI Number | 1992195192 |
|---|---|
| Provider Enumeration Date | 01/27/2015 |
| Last Update Date | 06/02/2023 |
| Certification Date | 06/02/2023 |
| Medicare PECOS PAC ID | 8921327644 |
|---|---|
| Medicare Enrollment ID | O20150430002606 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992195192 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Secondary |
| 261Q00000X | Clinic/center | 1296 (Wisconsin) | Primary |
| Provider Name | Russell Kinkade |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1033295571 PECOS PAC ID: 0446437602 Enrollment ID: I20150824001097 |
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