Northwest Journey - Ellsworth
Organization Active NPI Adolescent and Children Mental Health Clinic/Center · Ellsworth, WI
NPI 1306965033 · NPPES record last updated Sep 23, 2010
Key facts
- NPI
- 1306965033
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Adolescent and Children Mental Health Clinic/Center 261QM0855X
- License
- 2326 (WI)
- Legal business name
- NORTHWEST JOURNEY - ELLSWORTH
- Practice address
- N6096 530TH St
Ellsworth, WI 54011-5107 - Phone
- (715) 273-0203
- Fax
- (715) 273-0344
- NPI assigned
- Mar 27, 2007
- Organization subpart
- Yes
- Parent organization (as reported)
- NORTHWEST COUNSELING AND GUIDANCE CLINIC
Authorized official
- Name
- Mr. Nick Kalambokidis
- Title
- Cfo
- Phone
- (715) 327-4402
Corporate family (same tax ID) 21
National Provider Directory
- Tax ID family
- Northwest Counseling Center
- Part of
- Northwest Counseling Center
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adolescent and Children Mental Health Clinic/Center | 261QM0855X | 2326 | WI | Yes |
Addresses
Primary practice location
N6096 530TH St
Ellsworth, WI 54011-5107
Mailing address
N6096 530TH St
Ellsworth, WI 54011-5107
Phone (715) 273-0203
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 43006700 | Medicaid | WI | |
| 7H956NO | Other | MN | BCBS OF MN |
| 42626 | Other | MN | HEALTH PARTNERS |
| 1306965033 | Other | WI | HUMANA |
| 85575 | Other | MN | PREFERRED ONE |
| 1306965033 | Other | WI | VALUE OPTIONS |
Other providers in Ellsworth, WI
- Bridget Marie McConnell
- Michelle Jean Meinen
- Richard Allen Moldenhauer
- Hannah Newman
- Gayle Ann Nissen
- NSH Ellsworth LLC
- Nyeggen Chiropractic SC
- Ronald Scott Nyeggen
- Laurie O'Neil
- Pierce County Dept of Human Services
All providers in Ellsworth, WI · Adolescent and Children Mental Health Clinic/Center in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 23, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.