Lisa Bredael
Individual provider Active NPI Counselor · Menasha, WI
NPI 1003978859 · NPPES record last updated Nov 30, 2023
Key facts
- NPI
- 1003978859
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- License
- 3081 (WI)
- Practice address
- 1095 Midway Rd
Menasha, WI 54952-1115 - Phone
- (920) 720-2300
- NPI assigned
- Dec 15, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240115001544 | WI | Practitioner - Mental Health Counselor | 1658723739 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Thedacare, Incorporated | Counselor | Current |
Accepting new patients |
| Thedacare, Incorporated | Current |
Accepting new patients |
Locations
1818 N Meade St
Appleton, WI 54911
Phone (920) 731-4101
1095 Midway Rd
Menasha, WI 54952
Phone (920) 720-3700
3 Neenah Ctr
Neenah, WI 54956
Phone (920) 454-4229
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 3081 | WI | Yes |
Addresses
Primary practice location
1095 Midway Rd
Menasha, WI 54952-1115
Mailing address
3 Neenah Ctr
Neenah, WI 54956-3070
Phone (920) 720-2300
Other providers in Menasha, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 30, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.