| Sweetgrass Behavioral Health | |
|
102 E Green Bay St Ste 101 Shawano WI 54166-2444 | |
| (715) 280-8130 | |
| (715) 280-8138 |
| Full Name | Sweetgrass Behavioral Health |
|---|---|
| Speciality | Clinic/Center |
| Location | 102 E Green Bay St Ste 101, Shawano, Wisconsin |
| Authorized Official Name and Position | Alegra Fowler (OWNER) |
| Authorized Official Contact | 7152808130 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sweetgrass Behavioral Health 102 E Green Bay St Ste 101 Shawano WI 54166-2444 Ph: (715) 280-8130 | Sweetgrass Behavioral Health 102 E Green Bay St Ste 101 Shawano WI 54166-2444 Ph: (715) 280-8130 |
| NPI Number | 1508574328 |
|---|---|
| Provider Enumeration Date | 11/10/2022 |
| Last Update Date | 12/20/2022 |
| Certification Date | 12/20/2022 |
| Medicare PECOS PAC ID | 5597202556 |
|---|---|
| Medicare Enrollment ID | O20240808000470 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508574328 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Primary |
| Provider Name | Alegra Fowler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1962056382 PECOS PAC ID: 2466782362 Enrollment ID: I20190918003677 |
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