| Ywca Northeast Indiana Inc | |
|
1313 W Washington Center Rd Fort Wayne IN 46825-4142 | |
| (260) 424-4908 | |
| Not Available |
| Full Name | Ywca Northeast Indiana Inc |
|---|---|
| Speciality | Substance Abuse Rehabilitation Facility |
| Location | 1313 W Washington Center Rd, Fort Wayne, Indiana |
| Authorized Official Name and Position | Michelle Banks (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 2604244908 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ywca Northeast Indiana Inc 1313 W Washington Center Rd Fort Wayne IN 46825-4142 | Ywca Northeast Indiana Inc 1313 W Washington Center Rd Fort Wayne IN 46825-4142 Ph: (260) 424-4908 |
| NPI Number | 1629533658 |
|---|---|
| Provider Enumeration Date | 02/04/2019 |
| Last Update Date | 02/25/2025 |
| Certification Date | 02/25/2025 |
| Medicare PECOS PAC ID | 4385163831 |
|---|---|
| Medicare Enrollment ID | O20250528001328 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629533658 | NPI | - | NPPES |
| Provider Name | John F Newbauer |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1891818126 PECOS PAC ID: 5799194866 Enrollment ID: I20210503001505 |
| Provider Name | Brittany Ogden |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1043982119 PECOS PAC ID: 1456890094 Enrollment ID: I20240828000716 |
| Provider Name | Haley Criswell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255155818 PECOS PAC ID: 7618403221 Enrollment ID: I20241205003911 |
| Provider Name | Nicole D Johnson-smith |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1548816374 PECOS PAC ID: 3072001874 Enrollment ID: I20251023001345 |
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